Here we address interesting and important issues affecting the delivery of medical care and related topics.
We cover additional, related issues and discuss them in more depth on our blog.
November 29, 2017
A new technique in cancer treatment involves the use of nanoparticles to reach cancer stem cells hiding in the body after successful cancer treatment. New research has discovered that there are such things as cancer stem cells. Like other stem cells, these cells have the ability to develop into a variety of tissue but in their case it is always a cancer tumor. These cells, and there may be only a few of them, can hide in the body after successful treatment has killed all the other cancer cells. These stem cells can develop into new cancer tumors years after the earlier cancer was eradicated. The drug used with the nanoparticles is a common prescription medication which has the ability to turn off the genes in the cancer stem cells that allow them to stem. This effectively stops their ability to seed new cancers in the body.
November 17, 2017
There has been another new development in the battle against Type 1 diabetes. I am very interested because my young grandson was diagnosed with Type 1 when he was three. In the latest advance, which appears to hold substantial promise, researchers used gene therapy to reprogram blood cells to reduce the immune response of the body. When applied to diabetic mice, the therapy reversed their Type 1 diabetes and made them normoglycemic in the short run. In the long run, fully one-third of the mice remained normoglycemic. Very impressive.
November 14, 2017
New guidelines from the American Heart Association and the American College of Cardiology have significantly lowered the threshold for what constitutes hypertension or high blood pressure. Instead of 140/90, the new threshold is 130/80. Under the new guideline fully 46% of the American people will be hypertensive, including many young people. The medical community wants these people to reduce their blood pressure readings by healthier eating and more exercise as opposed to medication. The sooner in life one begins this regimen, the better for their overall health. Healthier eating and exercise is good advice for anyone.
November 9, 2017
When asked to name things which can cause cancer, very few Americans would list drinking alcohol. While we are well-aware of many of the dangers posed by alcohol, we don’t usually think of cancer. Even moderate drinking is associated with an increase in the risk of breast cancer in women and increased risk of mouth, throat and esophageal cancers in men and women. Those who warn us of this risk do not urge us to stop drinking. They do urge that, if we drink, we drink moderately and, if we do not drink, do not start. This is sobering advice.
October 27, 2017
When there is big money to be made, medical ethics fall by the wayside for some doctors and patients and the public pay the price. The billionaire doctor heading a drug company that makes a potent synthetic opioid spray for terminal cancer patients has been arrested by federal agents for engaging in a scheme to bribe doctors to prescribe his company’s products to patients who were not candidates for it. The drug was very expensive with a 30 day supply costing anywhere from $3,000 to $30,000. Here is a link to the story. The scheme required the bribed doctors to lie about the condition of their patients in order to get insurance companies or Medicare to pay for the drug. A number of patients have claimed they were harmed by receiving this extremely potent narcotic drug when they did not need it. The more potent the narcotic, the greater the danger of addiction. More patients will undoubtedly step forward as this scheme becomes more widely known.
October 19, 2017
There is an increasing incidence of throat and neck cancers among men caused by human papilloma virus (HPV). As with so many other things, smoking makes things worse. Here is a story about the situation. The important part of the story is that there is a vaccine which is safe and is effective against the forms of the virus that are most likely to cause these cancers. More girls get the vaccination, which prevents uterine cancers in women, than do boys. To be most effective, however, the vaccine should be administered before a male has his first sexual contact. The CDC recommends vaccination at ages 11 and 12. Parents get your sons vaccinated.
October 16, 2017
Here is a nice article on the microbes which share our living spaces with us and the extent to which many of them turn out to be good for us. It is widely believed that living in a completely antiseptic environment gives the immune system nothing to do and it sometimes responds by deciding that our own organs are invaders who need to be attacked. Don’t make that house too clean.
October 12, 2017
Money and greed leads to schemes to steal from all of us. Four Houston area hospitals were caught receiving kickbacks from ambulance companies in exchange for the hospitals using these companies to transport Medicare and Medicaid patients. The hospitals agreed to pay $8.6 million to settle the kickback claims, which were brought by the Centers for Medicare and Medicaid Services.
October 9, 2017
Here is a feel-good story with a call to action. Researchers have discovered a way to address a rare form of brain disease that strikes mostly young boys and kills them by the time they turn 10. The treatment involves a bone marrow transplant which is often effective in stopping the disease in its tracks. There is, however, a catch. Treatment must be initiated before the child develops significant symptoms. Without some advance warning that your child might be at risk for this rare disease, by the time it is diagnosed, it is already too late. This is where the call to action comes in. Children can be screened for the genetic mutation responsible for the disease and, if the test is positive, they can be monitored so that the treatment can be given in a timely manner, if they show signs of developing a serious form of the disease. Only a handful of states require routine testing of children for this disease, ALD (adrenoleukodystrophy). Don’t let the children of your state be killed by this disease. Lobby your representatives to require routine testing in your state.
October 4, 2017
As if we needed more evidence that being poor adversely affects health, a new study from the University of California at Irvine demonstrates that children born in affluent neighborhoods are less likely to be born prematurely or to be low weight at the time of birth than children born in poorer neighborhoods. It appears not just to be the result of better educated, healthier parents in the more affluent neighborhoods but also more community resources are available in these areas to support expectant mothers.
September 6, 2017
A new study concludes that PSA testing does reduce overall deaths from prostate cancer, a question which had been the subject of much debate. Unfortunately, this reduction in the overall death rate comes at the price of serious overtreatment of prostate cancer. According to physicians who specialize in prostate cancer, for every one life saved by early testing, five men receive aggressive treatment they do not need. This is significant because the three definitive treatments for prostate cancer all are likely to leave the patient impotent or incontinent or both. In our Blog post on Monday, I will discuss strategies physicians are employing to persuade patients to choose watchful waiting over aggressive treatment which is likely to change their lives in unpleasant ways.
August 31, 2017
The poor citizens of Texas cannot catch a break. Just as southeast Texas is being inundated with a flood of biblical proportions, a new insurance law passed by the Republican-controlled legislature is scheduled to take effect tomorrow. The law is a gift to the insurance industry, which undoubtedly contributed substantial amounts to the legislators who passed the new law.
The law places new limitations on claims by policyholders that their property or homeowners’ insurer has delayed or unfairly denied a claim for property damage. The aggrieved homeowner must send a notice of claim to the insurance company and offer the insurance company a “reasonable” opportunity to inspect the property before suit can be filed. Of course, any reasonable insurance company trying to do the right thing will have inspected the loss long ago. Since the property owner’s suit will be abated if these requirements are not met, there will undoubtedly be litigation about whether the notice was sufficient and the opportunity to inspect was “reasonable.” The law also limits what attorney’s fees can be awarded the property owner which will make it harder for the property owner to get legal representation. The law does not in any way restrict what the insurance company can pay its lawyer or what it can recover, if the property owner loses the case. All in all a slap in the face of consumers who were already facing property damage hell due to Hurricane Harvey.
August 30, 2017
Watch your step. According to a story in yesterday’s Wall Street Journal, physicians can learn a lot by watching how older Americans walk. Very small gait disturbances can signal the onset of cognitive problems, including dementia and Alzheimer’s, years before any symptoms appear. The linkage is based on the fact that the executive functioning of the brain is very important to walking. Deterioration in the portion of the brain which controls executive functioning affects gait. Scientists are studying whether exercises to improve cognitive functioning can be effective in staving off brain decline and in reducing the risk of falls for elderly patients.
August 18, 2017
Here is a link to a short post about selected medical malpractice awards to plaintiffs in the first half of 2017. Notably, the number of medical malpractice filings continue to decline in response to the hostile jury climate. Doctors and hospitals continue to win most of the cases which go to trial and legislatures, including Congress, continue to enact laws to make it harder for victims of malpractice to recover and to hold down the verdict when they do.
August 14, 2017
It seems these days as if science fiction writers cannot catch a break. No matter how outlandish their predictions about our future, science keeps turning those predictions into reality. The latest example is the news that scientists have figured out a way to modify the genes in pigs to eliminate retroviruses which have been one of the greatest barriers to using pig organs for transplant into humans. If pigs can be raised for organ donation, it will open a whole new frontier in transplant technology. No more shortage of organs. No more years-long waiting lists for transplants. The only ones not enthused about this are the pigs. Oink.
August 11, 2017
We have discussed in our blog the problems associated with the use of power morcellators during uterine fibroid surgery. Here is a link to the latest FDA warnings concerning the risk of power morcellators spreading an unsuspected cancer during routine fibroid surgery. In sum, the FDA says the risk is too great and that power morcellators should not be used for most patients. While this is an important warning, it was long overdue.
July 12, 2017
Researchers in Great Britain believe they can scan the heart with such precision that they can identify fat cells which are becoming the atherosclerotic plaque deposits which clog coronary arteries and cause heart attacks. Here is a link to a story describing their findings. If successful in early detection, the researchers believe doctors can prescribe medications or other therapies which will stop the plaque formation and avoid the later necessity for interventional procedures such coronary artery bypass grafting and stenting.
June 26, 2017
Two interesting medical malpractice verdicts were returned this year in cases involving loss of a testicle. Both were in Pennsylvania but one was in the more liberal Philadelphia area while the other was in the more conservative western part of the state. In the Philadelphia case, the jury returned an $8.5M verdict after a man lost a testicle due to a failure to diagnose testicular torsion, a twisting of the blood vessels causing a loss of blood flow and subsequent tissue death. In the more conservative side of the state, a jury awarded only $870,000 when a surgeon who was to remove a cancerous testicle instead removed its healthy neighbor. This despite the fact that testimony showed the cancerous testicle was twice the size of the healthy one. The second verdict included a $250,000 punitive damage award so it is clear the second jury was very unhappy with the surgeon. There was no punitive damage award in the first case. The two very different valuations for loss of a testicle show that sometimes there is just no way to predict what a jury will do.
June 12, 2017
What prompts a patient in the emergency department to agree to undergo a diagnostic test or, in the alternative, to refuse? A recent experiment performed on line by the Michigan Center for Integrative Research in Critical Care tried to answer that question by comparing outcomes with changes in risk, benefit and cost. Perhaps predictably so, the most important variable was cost. If the insurance company was paying the whole cost of the test, patients were usually willing to have the test. If patients had to pay themselves, they were less likely to have the test if the cost was high, the risk of the test was high or the benefits of the test were low. In deciding how to keep health care costs down or how to prevent doctors from ordering tests for their benefit and not that of the patient, the results of this study shows us the importance of the patient “having some skin in the game.” Patients who have some economic interest in whether the test is done or not will not always agree to go along and may actually make reasoned decisions. On the other hand, as pointed out by the study’s authors, you don’t want patients foregoing needed tests because they cannot afford them.
June 9, 2017
I have a grandson with Type 1 diabetes. Things are rapidly changing in his world. A new insulin pump has been approved that communicates with a glucose sensor, the first iteration of what has been called “the artificial pancreas.” Another development is far from being approved for human use but is intriguing nonetheless. Researchers are working to develop a tattoo that will change color depending on the person’s blood sugar levels. Here is a link to a story about this and tattoos that monitor other biological functions as well.
June 5, 2017
The results of a small test using new cell and gene therapy to cure multiple myeloma, a form of blood cancer, have been surprisingly good. Every one of the 35 patients in the study responded favorably to the treatment. All but two achieved some form of remission. The ability of a therapy to prove successful with 100% of the patients receiving it is almost unprecedented. Further testing with larger cohorts will be necessary and only time will tell how well the first 35 patients continue to do but the results to date are extremely impressive.
The test was run by Chinese researchers and the results announced at a conference of the American Society of Clinical Oncology.
May 15, 2017
Although they don’t know why, doctors in Australia have found that colds, the flu and other respiratory illnesses significantly increase the risk of heart attack according to a study published in the Internal Medicine Journal. The risk of heart attack was 17 times higher in the first 7 days after symptoms of the respiratory infection appeared. Among the possible explanations are that these respiratory infections increase blood clotting and inflammation, both of which are known factors in causing heart attacks.
March 29, 2017
Fake doctors committing malpractice are in the news again. A fake doctor in Florida who was performing procedures to make patients’ rear ends look better has been convicted and sentenced to ten years in prison. The fact that she was using a mixture of cement, bathroom caulking and mineral oil did not help her case.
Make sure your doctor is licensed and both trained and experienced in the procedure you are contemplating. This is especially important when considering a cosmetic procedure as many doctors who do not have training in plastic surgery are holding themselves out as plastic surgeons to take advantage of the booming market in cosmetic procedures.
March 27, 2017
Hardly a day goes by without some encouraging news in the fight against Type 1 diabetes. Type 1 is an autoimmune disease in which the person’s own body destroys the pancreatic cells which make insulin. Without insulin to provide energy to the cells, you die. There is no cure and the effects of uncontrolled Type 1 can be fatal. Today’s news involves discovery of a biomarker which may identify those at risk of developing Type 1 diabetes. Once the autoimmune process begins, it can go quickly and, if not recognized in time, can result in the dangerous and sometimes fatal condition known as diabetic ketoacidosis. Additionally, research has shown some promise in slowing the onset of Type 1 diabetes in patients who still have some pancreatic function remaining at time of diagnosis so early detection can be valuable in a number of ways.
March 23, 2017
Sepsis is a serious and widespread infectious process which affects the organ systems of the body. It often causes them to fail which results in death. It is reported to be the most costly medical condition in the United States.
It is difficult to reverse sepsis once it takes hold and there is a high incidence of death among sepsis patients. In what may turn out to be one of the more important medical discoveries in years, a team of physicians from Norfolk, Virginia has conducted a small study in which the mortality rate for patients with advanced sepsis was reduced from 40% to 8%. Even more surprising was the fact that they accomplished this with the intravenous use of three routine, low cost and low risk substances: Vitamin C, hydrocortisone and thiamine. While more study is needed, the treatment is not one likely to harm the patient and may be a huge breakthrough in the treatment of this often deadly complication.
March 21, 2017
During the Great Recession of 2008-2011, the annual numbers of new cases of lung, prostate and colorectal cancers dropped. In view of the aging of the baby boomer population, the numbers should have been going the other way. This got researchers thinking. Was this a real drop or were people just too spooked to spend money on the medical testing and visits they would have had but for the recession? Turns out it was the latter and the drop was found to exist every time we have had a big recession. Not going to the doctor or not getting your routine screening may save some money in the short run but allows undetected cancers to take root. As the old car repair ad said, “Pay me now or pay me later.” The later bill can be a whopper when it is due to untreated cancer.
March 20, 2017
When Willie Sutton, the famous bank robber, was asked why he robbed banks, he is reported to have responded, “Because that’s where the money is.” Well, today the money is in the Medicare system, which dispenses hundreds of billions of dollars of federal money each year. That amount of money is bound to attract fraudsters and it does. Doctors, nurses, nursing home operators and others routinely submit false claims to Medicare and make off with hundreds of millions of dollars each year. Last week the Department of Justice announced the guilty plea of a Houston area nurse who assisted a hospital and nursing home operator in the submission of over $5,000,000 of false claims. The operator paid illegal kickbacks to get patients referred to his facilities and submitted invoices for care that was either medically unnecessary or was never provided. When they do this, they steal from all of us. The defendant will be sentenced in August.
February 21, 2017
There is medical malpractice and then there is really bad medical malpractice. The latter tripped up a Dallas area neurosurgeon who was either (take your pick) so incompetent that he maimed several people permanently or acted intentionally to injure them. He was convicted of the felony of intentionally or with criminal negligence injuring an elderly person. He has been sentenced to life in prison. Why can’t the medical profession identify and remove these people before they damage so many people?
February 16, 2017
Fascinating news out of the New England Journal of Medicine. Your likelihood of becoming becoming a long-term user of opiod medications is influenced greatly by the attitudes of the emergency department doctor you see following an injury. This is especially true if you are an older American. If the doctor is aggressive about prescribing narcotic pain medications, your chances of long-term use are much greater than if the doctor uses narcotics sparingly. How you start treatment of an injury has lasting consequences. Long-term narcotic use is particularly bad for older Americans as it increases the risk of falls, constipation, confusion and addiction. Here is a link to a New York Times article on the subject.
February 14, 2017
The American College of Physicians has just issued some new guidelines for the treatment of back pain not caused by discs pinching nerves. The guidelines are based upon a review of more than 150 studies of patients with back pain. Put in their simplest terms, the guidelines urge that patients try exercise, heat, massage, acupuncture and spinal manipulation first. If these are not effective, physicians should consider addressing possible depression in patients with chronic back pain. Only if all these are ineffective should drugs be considered and then physicians should begin with over the counter medications like Advil. The last and final resort among medications should be opiods and then only after a thorough discussion of the risks and benefits of their use. Opiods, when used, should be prescribed in the smallest possible dose and for the shortest possible time to address the problem.
February 7, 2017
As if we needed another reminder, here is another study showing the positive benefits of exercise, this time on the heart. This study showed that gene expression was affected by endurance exercise in mice. Other studies on humans have shown better weight control, better control of lipids, improved mood, better blood flow to the brain, increased formation of new brain cells, delayed effects of aging and on and on. Pretty much nothing is better for you than exercise and it is never too late to get up off the couch and start doing something.
February 2, 2017
We have blogged in the past about antibiotic resistant bacteria being spread by endoscopes, which are long, slender, tubular optical instruments used to examine the inside of the body such as the colon or the stomach. Very little attention was given to the problem at first but then people started dying. It was thought that the problem was that the institutions in question had simply not been thorough enough in cleaning their endoscopes between use. Now a study out of Minnesota shows that it is nearly impossible to completely clean the scopes. Most of them develop small scratches or dents which complicate the cleaning process. However, even those which are not damaged, have crevasses and tight spaces that provide a refuge for bacteria. This is very worrisome as endoscopes are necessary for a great many important medical procedures. If they can’t be adequately cleaned no matter how hard the hospitals try, how risky is it to have one used on you and is it worth that risk?
November 16, 2016
There is good news and bad news about cholesterol and atherosclerotic disease. For years doctors have been prescribing statins to lower bad cholesterol in their patients. Many of the original statins are off patent now and very inexpensive. This is a real boon for the many Americans with high cholesterol. While statins help keep plaque deposits from forming by keeping the levels of bad cholesterol in check, they do not reduce the plaque deposits which are already there. The good news is that a new class of drugs has been developed which, when given along with aggressive doses of statins, can actually reduce the amount of plaque in the arteries. The amount of plaque reduction was not very great but the length of the study period was not that long and researchers are hopeful that with more time there will be an even greater reduction in the amount of plaque. They also hope that additional research will result in a more effective medication. The bad news is that a year’s treatment costs $14,000 and many insurers refuse to pay for it.
October 25, 2016
A very scary article appeared in today’s New York Times. It pointed out that, at least so far, the Zika virus has not damaged many babies. By contrast cytomegalovirus (CMV) has damaged many babies and yet there is very little awareness of the risk it presents or advice to pregnant women on how to avoid it. Pregnant women need to be aware of CMV, the damage it can cause their unborn babies, how to avoid it, and how to test their babies for it after they are born. Certainly worth your time to read.
October 21, 2016
Another example of doctors behaving badly. A doctor and his co-conspirator were sentenced in Louisiana for their roles in a scheme which defrauded you and me and the Medicare system of $34M. As is often the case, it was a home health care scheme. And, of course, they used “Christian” in the name of their health care business.
October 14, 2016
The Justice Department just announced that Yavapai Regional Medical Center of Prescott, Arizona will pay the Department of Health and Human Services $5.85 million to resolve charges that it violated the False Claims Act by misreporting the number of hours worked by its employees and thereby significantly overcharging the Medicare program.
October 4, 2016
Surprisingly, or perhaps not so surprisingly, a recent study has shown that your doctor does not leave his or her political beliefs behind at the office door. While on most issues, political affiliation does not affect medical care or advice, there are some hot-button social issues that apparently influence the advice doctors give their patients. The study noted the differences most acutely on issues such as abortion, guns in the home where children are present and marijuana usage. Doctors are people too and, like us, their world view affects all aspects of their private and work lives.
September 24, 2016
A Baltimore jury awarded $10 million this week to the family of a man given a medication which destroyed his colon and killed him. The award was made against the University of Maryland Medical System. The system expressed diappointment at the jury’s verdict and promised an appeal.
September 13, 2016
Here is a very informative article on prostate cancer screening. Among other things, it points out the slow growth of most prostate cancers and the dire physical consequences of most prostate cancer treatments. The digital rectal examination, known and loved by all men, is no better at detecting prostate cancer than the PSA test, so there is no need to do it. The PSA test, however, is prone to false positives unrelated to prostate cancer. These false positives result in unneeded tests and treatment. Even if prostate cancer is found to exist, it usually does not need to be treated and the man will likely die of something else before the prostate cancer can kill him. For this reason, many in the medical profession recommend against even routine PSA testing for most men. An interesting medical question which men should discuss with their primary care physician before having another PSA test.
September 7, 2016
A Missouri woman was recently awarded $570,000.00 in a jury trial arising out of a medical malpractice claim. The plaintiff went to a pain clinic to have an injection done for back pain. Somehow during the procedure, the doctor broke off a 1 1/2 inch hypodermic needle in her back. Efforts to remove the needle have been unsuccessful. It has been in her back for the past seven years and is probably there for life. The pain clinic says it will appeal.
September 2, 2106
On August 31, I wrote about a San Diego area doctor who was trading narcotic prescriptions for sex. According to the DEA, the number of victims has grown to at least 25 with more people coming forward everyday. Sounds like he had a busy practice.
August 31, 2016
The bad news just keeps on coming for the medical profession. Lawyers often have a bad reputation in the community but there are far fewer stories in the news about lawyers engaging in the kind of gross misconduct being reported about doctors. Here is today’s story. A doctor was arrested today in the San Diego area and accused of prescribing narcotic painkillers to his patients with the intent to get them addicted and then trade sex for the prescriptions they would need to satisfy their addiction. You can’t get much lower than that.
August 26, 2016
Although it may sometimes seem that we are always critical of the medical profession, we do try to recognize those occasions when they make some of the many contributions they make to our well-being. Today is one of those days. Orlando Regional Hospital and Florida Hospital, two hospitals to which the victims of the Orlando nightclub shooting were taken for treatment, have announced that they will not be sending any bills to the victims or their families. If there is health insurance, they will accept that for the treatment they provided but if there is no health insurance or if the insurance is not enough to cover all of the bills, the hospitals will not seek reimbursement. These are indeed hospitals which are members of the community and which take their responsibilities as caregivers seriously. Thank you, Orlando Regional and Florida Hospital.
August 25, 2016
Not sure how I missed this. In March Olympus Corporation of America agreed to pay over $623M to the government to resolve criminal and civil charges that it had been bribing physicians and hospitals and paying kickbacks for years to get them to use its products. Olympus is the world’s largest manufacturer of the scopes used in diagnostic procedures. The Olympus settlement is the largest in the history of the U.S. Anti-Kickback laws and is the product of a whistleblower complaint by a former compliance officer. That gentleman stands to receive $51M of the settlements as his reward for exposing the company and assisting the government in collecting the fines. Almost makes it worthwhile to be an ex-employee.
August 23, 2016
In 1999, the seminal study of hospital deaths caused by medical malpractice, “To Err Is Human,” concluded that approximately 98,000 people died in hospitals in the United States each year as a result of malpractice. An article in the BMJ recently concluded that with today’s population size, the figure is more likely 250,000 per year. In an OpEd piece which appeared last week in the New York Times, a physician takes issue with that estimate and argues that focusing on deaths caused by malpractice may be distracting us from other, real harms caused to living patients by malpractice. It makes for an interesting read.
July 26, 2015
This is the biggest health news I have seen in the last 20 years. A new study reported at a recent medical conference on dementia and Alzheimer’s found that a simple computer exercise performed over the course of 15 one-hour sessions reduced the chances of dementia by almost 50% over the next 10 years in the study group, which included individuals from their 60’s to their 90’s. Here is a link. It is not clear from the article whether the term “dementia” as used in the article includes Alzheimer’s or not but a big story even if it does not diminish the risk of Alzheimer’s.
June 22, 2016
Federal authorities have announced what they describe as the largest health care fraud crackdown ever. The defendants, who include among them 30 physicians, are accused of defrauding the Medicare and Medicaid programs of over $900 million. The scams included phony patients, phony prescriptions, unnecessary treatments and medical devices never delivered. Fraud is widespread and a major driver of health care costs. If your goal is to keep down the costs of medical treatment, control fraud before you ask citizens to give up their right to be compensated when they have been victimized by medical malpractice.
June 14, 2016
This week I blogged about caring doctors and asked where we as a society would be without them. Early Sunday morning, tragedy struck Orlando, Florida. Many dedicated doctors, nurses and other medical professionals were there to answer the call. Thank you to them and to all who stand ready to help us in our hour of need. Here is a brief story from one of them. I am sorry that I cannot get the picture into this post. It is very moving, as is his story. His new shoes are soaked with blood.
These are my work shoes from Saturday night. They are brand new, not even a week old. I came to work this morning and saw these in the corner my call room, next to the pile of dirty scrubs.
I had forgotten about them until now. On these shoes, soaked between its fibers, is the blood of 54 innocent human beings. I don’t know which were straight, which were gay, which were black, or which were hispanic. What I do know is that they came to us in wave upon wave of suffering, screaming, and death. And somehow, in that chaos, doctors, nurses, technicians, police, paramedics, and others, performed super human feats of compassion and care.
This blood, which poured out of those patients and soaked through my scrubs and shoes, will stain me forever. In these Rorschach patterns of red I will forever see their faces and the faces of those that gave everything they had in those dark hours.
There is still an enormous amount of work to be done. Some of that work will never end. And while I work I will continue to wear these shoes. And when the last patient leaves our hospital, I will take them off, and I will keep them in my office. I want to see them in front of me every time I go to work. For on June 12, after the worst of humanity reared its evil head, I saw the best of humanity of come fighting right back. I never want to forget that night.
Dr. Joshua Corsa M.D, EMT-P
Orlando Regional Medical Center
Senior Resident, Department of Surgery
June 7, 2016
A resident’s life is not an easy one. Residents work long hours learning the ins and outs of the medical specialty they have chosen. It is a very stressful time. Unresolved stress leads to burn out and increases the risk of medical errors. A number of institutions have recognized this problem and have developed programs modeled on one created by the Defense Department for active-duty military personnel and their families. They call it “resiliency training.” The data so far suggests that the programs have been successful in assisting the residents to develop coping skills which they can use when faced with the inevitable pressures and losses of residency and beyond. Here is a link to a story in the Wall Street Journal about the programs.
June 2, 2016
Dirty duodenoscopes are in the news again. I have blogged about them on a number of occasions in the past. My most recent post is here. It has links to older posts on the subject. Here is a link to a story in yesterday’s Los Angeles Times reporting that at Huntington Hospital in Pasadena 16 patients contracted serious bacterial infections from the dirty scopes and 11 of them had died. Interestingly, only one of the death certificates listed the bacterial infection as a cause of death. An investigation by the Pasadena Public Health Department blamed both design errors by the manufacturer and procedural errors by the hospital for the bacterial outbreak.
May 31, 2016
The Wall Street Journal has an article up about advances in testing for prostate cancer. Basically, there are two types of prostate cancer: the aggressive kind, which is likely to kill you, and the more indolent kind, where it is more likely you will die from something else before the cancer can get you. The new tests, many of which are expensive, often do a better job than traditional biopsies of detecting the presence of prostate cancer and assessing its aggressiveness. There is great merit in distinguishing between the aggressive form of prostate cancer and the less aggressive form which may only require careful monitoring. All three of the primary treatments for prostate cancer, prostatectomy, brachytherapy, and radiation therapy, leave patients with a greater than 50% likelihood of not being able to generate a functional erection. If you have the less aggressive form of prostate cancer, it is important to resist societal and family pressures to “do something about it.” Many who “do something about it” live to regret it. The new tests give greater reassurance that a less aggressive prostate cancer can be safely left alone and watched carefully.
May 26, 2016
On the subject of Medicare fraud, which steals from all of us, the Justice Department has just intervened in an existing whistleblower lawsuit alleging Medicare fraud by Prime Healthcare Services. Prime operates 14 hospitals, most of which are in Southern California. The Justice Department intervention comes after the government filed papers indicating its investigation had “yielded sufficient evidence” of Medicare fraud to justify its intervention and participation in the suit. The Justice Department’s decision to participate raises the stakes and makes it more likely that the whistleblower plaintiff will prevail in proving the alleged fraud, which is estimated to be approximately $50,000,000.00. Here is a link to the story in the Los Angeles Times. Prime denies all wrongdoing. We shall see.
April 18, 2016
We have blogged on a number of occasions about deadly superbug infections being spread by scopes used in endoscopic procedures. The blog posts can be found here, here, and here. There were outbreaks at a number of major hospitals and many people were killed or badly injured by the infections. The FDA has been investigating these incidents and the scopes which were used. One of the problems is that the manufacturer’s instructions for decontaminating the scopes after use were insufficient to actually clean them and when the scopes were used on the next patient, they were still dirty and infected. Now an article in the Los Angeles Times reports that more people were injured by these dirty scopes than previously thought. You can read the article here. As I mentioned in the last blog post, this story just keeps getting worse and worse.
April 13, 2016
Lots of scary news recently about the Zika virus. It is apparently even more damaging to unborn babies than previously thought. It can also cause some terrible damage to the neurological systems of adults. The mosquitoes which carry the virus have been found in 30 of the 50 states in the United States. This is a major health issue which deserves your attention, regardless of age or sex. Here is a link to the Zika virus page of the Centers for Disease Control. Please review it and keep going back as it will be updated as new information becomes available.
March 31, 2016
A few weeks ago, I reported in this space about new guidelines by the Centers for Disease Control and Prevention directed to doctors who prescribe opiate pain medications. The recommendations were to prescribe and little as necessary for as short a period as possible. They also recommended that prescribers check state databases for prescription drug usage (PDMP’s) to be sure their patients were not doctor shopping or already taking too much in the way of pain medications. The recommendation was for doctors to check before beginning to prescribe opioid painkillers and then regularly thereafter. However, according to news reports, this aspect of the recommendations are encountering some push back from physicians who claim it is an undue burden on them to check databases. We will have to see how this plays out but the databases are an important resource in the fight against prescription drug abuse.
March 23, 2016
I recently blogged about wrong patient/wrong site surgery. Today’s news has a story about a wrong site surgery at the Yale New Haven Hospital. The surgeons were supposed to remove the patient’s eighth rib due to a growth. She alleges and they admit that they removed the seventh rib instead. The patient claims that immediately after a radiologist informed her that the wrong rib had been removed, one of the surgeons approached her and told her that they had not removed enough rib and for that reason she would need another surgery. The hospital claims that it never misled the patient about the mistake.
March 21, 2016
Many people have to take warfarin, a blood thinner, for long periods of time to reduce the risk of blood clot formation. There is a substantial risk associated with warfarin usage, however, because if the level of warfarin gets too high, it can cause spontaneous bleeding and even a hemorrhagic stroke. Warfarin levels are sometimes hard to keep at safe levels as certain foods can affect them. Those taking warfarin need to be checked regularly to make sure their levels are appropriate. There have been reported problems with a small device which is often used by doctors to measure warfarin levels. The FDA is investigating complaints that “serious adverse events” have been “linked to inaccurate performance” of the devices. According to the FDA, 18 deaths in 2014 and 2015 were linked to possibly faulty readings. The manufacturer, Alere, has recalled some of its INRatio and INRatio2 devices because of concern over adverse event reports. Keep and eye on this developing story.
March 16, 2016
In recognition of the heroin epidemic sweeping the United States, the Centers for Disease Control and Prevention yesterday issued guidelines for the prescription of opiate pain medications. It is widely believed that many current heroin users became addicted to opiates which were legally prescribed for them. When they could no longer obtain a prescription for opiates or no longer obtain them in the amount they needed to satisfy their addiction, or sometimes because they just could not afford prescription medication any longer, they turned to cheaper and readily available heroin. Until recently, there had been some research which suggested that long-term use of opiates was not dangerous. Manufacturers of opiate painkillers such as Oxycontin and Oxycodone used this to encourage doctors to freely prescribe opiates for their patients who complained of pain. The consequences of readily available opiates has been disastrous. The new CDC recommendations are based on the recognition that the risks of long-term use of these drugs greatly outweigh the benefits, except in the case of intractable cancer pain or end of life use. The CDC recommends that doctors prescribing opiates for pain prescribe the lowest possible dose for the shortest possible time.
March 1, 2016
From time to time we have blogged on the subject of prostate cancer and the difficulty in distinguishing between slow growing cancer and the more aggressive form. If the cancer is slow growing, watchful waiting may be the best option for sparing the patient the difficult consequences of the primary treatments for prostate cancer. On the other hand, if the cancer is aggressive, waiting may reduce the likelihood of successfully treating the cancer when it is recognized as aggressive. New research suggests that there is a strong predictive relationship between low levels of Vitamin D and aggressive prostate cancer when the Vitamin D level is tested at the time of discovery of the cancer. High levels of Vitamin D at diagnosis make it more likely that the cancer is slow growing and that watchful waiting is an appropriate strategy.
If Vitamin D levels in men are low, they are at risk for a number of possible illnesses and conditions. Those of us who are fair skinned and enjoy an active outdoor lifestyle in Arizona are almost certainly in better shape than darker skinned males living in climates that keep them indoors during much of the winter. Best advice now is that everyone should have their Vitamin D levels checked and, if necessary, take supplements to reach appropriate levels.
February 27, 2016
A prestigious hospital in Boston, Brigham and Women’s Hospital, is parting the curtain of medical secrecy, if only a little bit. It has taken its formerly private safety blog public to discuss medical errors at the hospital. Once a month, the hospital will discuss an error which either led to a patient injury or just missed causing an injury. The goal is to increase transparency and improve health care outcomes. The hospital will select topics it thinks offer the best chance to prevent similar occurrences in the future. Here is a link. Kudos to the hospital for addressing these issues.
February 16, 2016
In our blog, I recently wrote about the pernicious effects of secrecy in medical malpractice settlements. I also recently wrote about a study by a prominent medical journal which found that a small number of physicians were responsible for a large number of malpractice claims. Now a neurosurgeon turned medical malpractice lawyer has offered his view that we must have transparency to identify these bad doctors and stop them from harming still more patients. Dr. Lawrence Schlachter, whose medical career was cut short by injury, has seen the problem of secrecy from both sides. As a surgeon, he saw occasional malpractice and but not speak up. He did not consider it to be a big problem. As an attorney assisting people injured by medical malpractice, however, he has been shocked at the number of doctors who will come into court and lie to protect themselves or the profession. This is not right or sustainable. As Dr. Schlachter says, “More must be done.”
February 10, 2016
The State of Maine is considering an innovative medical malpractice reform. Under the pending bill a panel of physicians would review malpractice claims and decide which ones are meritorious. Injured patients would no longer have to go to court. The premiums that doctors pay for malpractice insurance would go to fund the panel and pay what the panelists determine are legitimate claims. One argument for the change is that patients with smaller injuries can never find an attorney to bring their case because the cases cost so much to prosecute. In an unusual alliance, the Maine Medical Association, the Maine Trial Lawyers Association and the Medical Mutual Insurance Company of Maine, which handles most of the malpractice claims in the state, are all opposed to the bill. Stay tuned to see what happens.
February 5, 2016
There is a scandal brewing in the pharmaceutical world which may affect your health and that of your family. The same drive for as much profit as possible, which causes drug prices in the United States to be the highest in the world, is causing some businesses to buy companies producing important drugs. The drugs in question are usually not protected by a patent. They are generic drugs. Anyone can produce them. For that reason, they ought to be cheap. However, because they are usually for rare conditions for which there is not a great demand, often only one company produces the drug. This gives unscrupulous investors the opportunity to but that one company and raise prices on the life-saving drug, sometimes by a multiple of hundreds. Even assuming another company decides to begin producing the drug, it will take at least a year to get it to market. During that time our greedy friends have made millions. Martin Shkreli, who refused to testify before Congress earlier this week, is the poster boy for these guys. Watch this develop as public outrage over these rip off artists collides with politicians who get donations from Big Pharma and who don’t want to do anything to upset Big Pharma’s profit-making apple cart.
January 28, 2016
In an article published in today’s edition, the New England Journal of Medicine, one of the most prestigious medical journals in the world, reported that only 1% of the doctors were responsible for 33% of the amounts paid to settle medical malpractice claims in the United States between 2005 and 2014. We will be reporting on the important findings of this study by the medical profession itself in a post on our blog early next week.
January 18, 2016
When a patient suffers a traumatic brain injury (“TBI”), he or she is often at risk for a dangerous rise in intracranial pressure as the result of brain swelling. Brain swelling can reduce blood flow to parts of the brain resulting in permanent brain damage. At its worst, an increase in intracranial pressure can cause the brain to push its way out of the base of the skull, a usually fatal condition called brainstem herniation. While there are sensors which can monitor intracranial pressure, they are bulky and unwieldy. Researchers at Washington University in St. Louis have developed wireless sensors which can be placed in the brain and which dissolve in a few days, after their work is done. Animal tests have been successful and the researchers are getting ready for tests in humans.
January 12, 2016
The wonders of genetic testing are about to get even more wonderful. Scientists and physicians have known for years that the blood of a cancer patient contains microscopic pieces of dead and dying cancer tumors. A new company is being formed to develop a relatively inexpensive blood test to detect these tiny markers long before conventional cancer testing can find them. The effort is promising enough that it has attracted major funding from Bill Gates and other sophisticated and knowledgeable investors. Here is a link to one story about the effort.
November 17, 2015
Back in August we reported the finding that hot sauce was could be good for your health, at least in the amounts used by regular people. Now there is news that another food favorite may be good for you. Researchers report that regular coffee drinking, even decaf, is correlated to a lower risk of death and disease. Researchers think it may be due to the presence of antioxidants in the coffee. The benefits were less in smokers but there is no surprise that the bad effects of smoking can outweigh pretty much anything else. So, coffee drinkers, have another cup and feel good about it.
November 16, 2015
A few years ago, we reported in our blog on the problems with PODS (“Physician Owned Distributorships”), companies formed by surgeons to sell to hospitals the medical equipment they intend to place into the bodies of their patients. The PODS gave the doctors a financial incentive to perform surgery and to place medical equipment the patients might not need. We reported that the Justice Department was investigating a California neurosurgeon suspected of performing unnecessary neurosurgery in an attempt to defraud the Medicare system. While PODS have not been in the news recently, that may change soon.
The Senate Finance Committee is holding hearings on PODS to determine, in their words, “Are they harmful to patients and payers?” One of the first witnesses invited to testify is Dr. Scott Lederhaus, president of the Association for Medical Ethics. Dr. Lederhaus has been a vocal critic of PODS and their role in turning surgeons into salespeople who make an added profit by buying the medical equipment at wholesale and selling it to the hospitals at retail. According to the Office of Inspector General, 20% of all spinal fusion operations in the United States in 2011 used POD implants. The Association for Medical Ethics asserts that PODS create conflicts of interest which contribute to the overuse of spine surgery. They say they want to expose PODS for what they are – “profit at the expense of patient care.” Stay tuned and be concerned if your surgeon owns a POD.
August 6, 2015
Have some hot sauce on that taco. On second thought, give me some on my Buffalo wings too. Another study, this one out of China, has shown that people who eat spicy foods have longer life spans, fewer cancers and less ischemic heart disease. Although the researchers don’t know for sure why this would be, they note that capsaicin, the active ingredient in peppers, has anti-inflammatory and anitoxidant properties. Here is a story with a link.
July 8, 2015
A Detroit doctor has pleaded guilty to federal fraud charges for billing insurance companies and Medicare millions of dollars for unnecessary cancer treatments for his patients. Patients and the families of patients are testifying at the penalty phase at which the judge will decide on his sentence. This physician violated his sacred oath by telling some patients they had cancer when they did not and by ordering costly and painful treatments for some patients who did have cancer but did not need the treatments. All for money. He was found out only when a young doctor saw one of his patients and correctly concluded that the patient had been diagnosed with non-existent cancer to justify high doses of expensive medication. The “fee for service” model under which a doctor gets paid for treating sick patients tempts some doctors to overtreat or overcharge. We need a different method of compensating doctors.
May 29, 2015
Availability of health care has become an even greater problem for rural Americans as more and more physicians choose to specialize and to practice in urban areas. More and more states are responding to this trend by allowing nurse practitioners greater freedom to practice medicine. Here is a good article on the subject from the New York Times. Not surprisingly, the authority granted to nurse practitioners has been fought by the doctors, who oppose it on the grounds that the nurse practitioners are not qualified to practice medicine without the supervision of a physician. While there may be some merit to this argument, it does nothing to address the fact that in many rural communities in which nurse practitioners live and work, there is no doctor to act as supervisor. The men and women who work as nurse practitioners are well-trained and the communities in which they live and work should not be deprived of medical care because doctors are concerned about losing income or power. If doctors are truly worried about the quality of care offered by nurse practitioners, there are ways to address it without harming poorly served communities.
April 24, 2015
Congratulations to the Wall Street Journal. It won a Pulitzer Prize for investigative journalism for its series “Medicare Unmasked.” We have covered parts of its investigative pieces in our blog over the last two years. The Journal went to court to force disclosure of Medicare payment information which the medical profession had been keeping secret since the 1970’s. The information the Journal has uncovered will help individual patients and will help make our Medicare system more transparent and less susceptible to fraud. The investigative pieces have uncovered doctor and hospital conduct which are both unethical and which are evidence of malpractice.
April 15, 2015
There is some disturbing news in a story from today’s Wall Street Journal about the indictment of a Florida doctor for Medicare fraud. The story discusses the problem of Medicare fraud and estimates it at 10% of all Medicare spending, or about $58 billion per year. Last year the government was only able to recover about $2.86 billion from Medicare fraudsters. Most of the fraud involves overcharges, fake patients and our old friend “medically unnecessary tests.” I am sure that, if you asked them, the fraudster doctors who were bilking Medicare for unnecessary tests would claim that they ordered them for fear of malpractice suits.
April 14, 2015
Although many people may not know it, there are vaccines against cancer. One of the most effective is the HPV vaccine which protects against cancers caused by human papillomavirus. These cancers include cervical, vaginal and anal cancers in women. The virus also causes cancers in men including penile, anal, mouth and throat cancers. Lastly, the virus causes genital warts in both men and women. Until recently the focus of health authorities has been on getting pre-teen girls vaccinated. Now the focus has been broadened to include boys 11 and 12.
The vaccine is safe and effective. What kind of a no brainer is it to prevent cancer. As parents we owe our children the best possible futures. Get your child, boy or girl, vaccinated against HPV.
March 30, 2015
As is the case in most other states, Wisconsin is reporting another drop in the number of medical malpractice cases being filed. Only 84 were filed in 2014 compared to 294 in 1999 and 140 in 2013. Profits for medical malpractice insurers in Wisconsin are soaring and have been since 2005. At the same time, doctors are getting large reductions in malpractice premiums. Observers attribute the drop in suits and the high insurance company profits to roadblocks which have been erected to keep injured patients from recovering when they have been the victims of medical malpractice. Significantly, none of this good fortune for doctors and their insurers appears to be translating into lower health care costs for the public.
March 20, 2015
The attitudes of juries in Arizona toward medical malpractice cases may be changing slowly but surely. Doctors and hospitals still win almost 90% of the malpractice cases which go to trial but in the last couple of weeks there have been some victories for injured patients. In Phoenix a jury awarded $5M in a medical malpractice case and in Tucson a jury just awarded $6.5M for the death of a patient. Stay tuned.
February 3, 2015
In 1979 the American Medical Association went to court to prevent the federal government from revealing to the public how much Medicare pays to doctors. It sought and received an injunction which forced the government to keep the payment information a secret. In 2013, the Wall Street Journal challenged the injunction and got it lifted. The government then revealed the payment information for its most recent year. Not surprisingly, the data showed that some doctors were ripping off the system. The data formed the basis for a series of articles in the Journal about abuses which were costing taxpayers millions. Now the Centers for Medicare and Medicaid Services, the agency that runs Medicare, has committed to continue to disclose yearly payment information. While this may not seem like a big deal, it is. We have always recommended that patients be careful consumers of the services that hospitals and doctors are selling to them. In this connection, it is probably a good idea to see what your doctor gets paid by Medicare and have some concerns if he or she is collecting an amount out of proportion to what similar doctors in the area are charging.
December 10, 2014
We spend more on breast cancer treatment annually in the United States than on any other form of cancer treatment. Today the emphasis is on breast sparing treatments for early stage breast cancer. The recommendations are for women who have undergone breast conserving surgery such as a lumpectomy to receive whole breast irradiation following surgery.
In 2011, the American Society for Radiation Oncology endorsed practice guidelines for whole breast irradiation. They recommended that certain women undergo a shortened, less-expensive, whole breast radiation treatment with no loss in effectiveness. They stated that the data permitted other women with early stage breast cancer to undergo the shorter radiation treatment, also with no loss of effectiveness. Today, in a study published on line by the Journal of the American Medical Association (“JAMA”), the authors found that, despite these guidelines, most eligible women were not receiving the shorter course but were getting a longer, more expensive course with no appreciable additional health benefit. The article can be found here.
The authors conclude that despite the practice guidelines, we are spending way more than we should on post-surgery radiation treatment. Too many women are still receiving more expensive care which lasts longer and which offers no health or other benefits. The authors do not explore why the medical profession continues to perform what appears to be more expensive but unnecessary treatment on these patients.
November 20, 2014
Skin cancers are a particular problem here in Arizona where we have so many sunny days and receive more direct rays from the sun than many other states. Skin cancers account for nearly half of all cancer diagnoses. Melanomas are the most aggressive of the skin cancers and account for nearly 75% of deaths attributable to skin cancers, even though they make up far less than 50% of skin cancer diagnoses. Importantly, nearly all skin cancers can be cured if detected and treated early enough. Everyone, but especially those of us who have lived in Arizona and enjoyed its great outdoors for many years, should be vigilant about watching for changes which might mean the presence of skin cancer.
Any skin change, especially a change in a mole, may be a sign of skin cancer. Dermatologists use the ABCD method to distinguish melanomas from other skin conditions. A is for asymmetry; does the lesion have an uneven shape? B is for border; does the lesion have an irregular border? C is for color; does the lesion have uneven colors? D is for diameter; is the lesion greater than 6mm in diameter? Positive responses to these questions are concerning for melanoma.
All this is information which has been with us for quite a while. What is new is the rise of Apps which claim to be able to identify cancerous skin lesions. Unfortunately, the reviews concerning these Apps are not very favorable. While they can and do sometimes identify problem lesions, they sometimes misidentify a malignant lesion as benign. The consequences can be life threatening. Don’t rely on an App to tell you whether a suspicious growth is cancerous or not.
There is no substitute for vigilance. If you see a suspicious growth or change, get to a dermatologist for a professional opinion and a possible biopsy. If you do all that and are misdiagnosed, call us. We have represented a number of clients whose biopsies were misinterpreted or who were told that a melanoma was nothing but a wart. It is sad and rare but it does happen. If it does, we may be able to help.
November 12, 2014
While tragic, the manner of death of Joan Rivers should come as no surprise to anyone familiar with the statistics surrounding medical mistakes. Medical mistakes are the third leading cause of death in the United States, accounting for between 200,000 and 400,000 deaths per year. The exact number is not clear due to the fact that doctors and hospitals rarely publish data about how many of their patients die from preventable medical errors.
Older Americans, such as Ms. Rivers, are at greater risk of death due to medical mistakes because they take more medications, have more chronic health issues, have more hospital stays and undergo more medical procedures. With so many people being killed each year, common sense says that eventually someone famous will die due to a preventable medical error.
One of the noteworthy results of the investigation into the death of Ms. Rivers was the sheer number of medical mistakes which were made in her case. There were at least five major errors reported. Not all of them contributed to death in her case but there were certainly a lot of them for what was considered to be a high end medical practice catering to the rich and famous. You can only imagine what the poor and unknown get by way of medical care.
October 31, 2014
In 2006, nearly 65% of Americans supported the idea that the federal government had a responsibility to make sure that all Americans had health insurance. Today only half do. According to a paper which appeared earlier this week in the New England Journal of Medicine, the loss of support is almost certainly the direct result of negative ads pummeling the Affordable Care Act, aka Obamacare. From its inception through the beginning of 2014, over $445 million was spent on ads attacking the Affordable Care Act. Furthermore, just between August 1 and September 11, 2014, 37,544 anti-ACA ads ran. That is a lot of negative advertising and, despite Americans general dislike of negative advertising, it works. If the Act gets rolled back in whole or in part, look for fewer to be insured. This means that more hospitals and doctors will be stuck with bills their patients cannot pay. Of course, doctors and hospitals will not go out of business; they will simply increase what they charge those of us with insurance to cover the unpaid bills.
August 22, 2014
A surgeon in Canada has developed a “black box”, similar in concept to the data recorders carried in all airliners today. The device will record what happens in the operating room and alert the surgeon if he or she begins to deviate from best practices or makes certain errors. It uses video and audio recording and monitors such things as what instruments are used, how they are used and group dynamics among the operating room team. A link to a news article about the device can be found here.
Look for the medical profession to resist its adoption unless the information recorded is able to be kept secret from the patient and from regulators. In the view of the medical profession, patients should know no more than their doctors are willing to tell them. If you have ever been injured in a surgery or by what you think is a medical mistake, you have undoubtedly had a great deal of difficulty trying to find out what happened. The cone of silence drops down and no one wants to discuss why you were injured. While doctors work hard to keep their mistakes secret, they complain about “frivolous malpractice suits” that seek to hold them accountable.
August 9, 2014.
Diabetes is a serious and growing health problem in this country and throughout the world. Type 1 diabetes, which used to be called Juvenile Diabetes, is on the rise for reasons which are not clear to health care professionals. Type 2 diabetes is also on the rise but its rise is linked, at least in part, to rising rates of obesity. While much time and money is being devoted to curing diabetes, for those who are afflicted with it, the watchword is control. It is extremely important that patients control their blood sugars. The results of failure to control may not appear for years but when they do, they are usually irreversible. The results include circulation problems, blindness, kidney failure, limb amputation, heart disease, stroke, neuropathies and many more.
As if we needed more proof of the effects of income disparity, a recent study has shown that diabetics living in lower income areas are more likely to lose limbs to the disease than diabetics living in more affluent areas. A report of the study can be found here. If you have diabetes, regardless of where you live, seek out treatment and control your blood glucose levels. If a friend or a loved one has diabetes, urge them to seek treatment. Left untreated or poorly controlled, diabetes kills in a lengthy and most unpleasant way.
The Commonwealth Fund is a charitable foundation dedicated to the improvement of health care in the United States. On a regular basis, it examines the state of health care in this country and compares it to outcomes and physician and patient satisfaction in other developed countries. As has been the case since it began issuing these reports, the news is not good. Its most recent report, which can be found here, reports that, although the most expensive in the world, health care in the United States underperforms on most measures compared to the other developed countries in its survey. The United States fails to achieve better health care outcomes and is last or nearly last in access, efficiency and equity. In the most recent report, the United Kingdom ranks first with Switzerland a close second. Even if we were not spending more than everyone else on health care, we as a nation deserve better than this.
The Wall Street Journal has some good advice for you: Check your medical records. According to the Journal, studies show that as many as 95% of patient charts have errors in medication lists. This can be a big problem as doctors may prescribe medications which duplicate the features of medications which their patients are taking but which are not listed in the patient’s chart. Or the doctor may prescribe a medication which interferes with a medication the patient is taking. On the other hand, a doctor may fail to order a medication in the mistaken belief that the patient is still taking it when the patient has actually stopped the medication. Lots of possibliities and lots of problems. As usual, the problems are greatest for seniors, the group which takes the most medications. Some doctors and health groups are giving their patients on line access to medication lists. If your doctor does, take advantage of it to make sure your doctor has a accurate medication list for you. If your doctor does not, at least tell him or her that you would like to compare your actual list with the list the doctor has.
Here are some interesting but somewhat contradictory findings about when to have your surgery. A study which was published last year in the British Medical Journal reported that the best surgical outcomes were associated with Monday surgeries and that they declined over the course of the week with the worst outcomes being associated with weekend surgeries. http://www.bmj.com/content/346/bmj.f2424 By contrast, a recent study on the subject of coronary artery bypass surgery found that outcomes for patients deteriorated if the surgeon had not operated on the preceding day or over the weekend or while on vacation. http://chess.uchicago.edu/events/documents/SurgeonHumanCapital_000.pdf At least according to these researchers, Monday surgery was associated with a small but statistically significant increase in patient mortality. There is already strong statistical proof that the more frequently a surgeon performs a procedure, the better the patient outcome. Maybe Tuesday surgery with a busy surgeon is the best choice, assuming your surgeon is not just returning from vacation.
A new report prepared by the Robert Wood Johnson Foundation addresses the issue of errors in diagnosis. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf412685 It points out that, while errors in diagnosis are the leading cause by far of malpractice claims, the problem of errors in diagnosis is routinely ignored by policymakers and administrators attempting to improve quality and patient health. It offers a number of explanations for this paradox and a number of solutions as well. We will be discussing the issue in more detail in our blog in the next few days.
Medication errors are one of the most frequent causes of injuries in hospitals. To their credit, hospitals are constantly trying to improve their medication administration systems and achieve greater patient safety. A new article in the journal, Drug Safety, surveys these efforts. http://www.ncbi.nlm.nih.gov/pubmed/24760475 Among the more effective stategies were automated drug dispensing, computerized physician order entry, barcode assisted medication administration, nursing education using simulation, and clinical pharmacist-led training. Better and safer medication administration is a good thing for hospitals and their patients.
Even Alex Rodriguez has been the victim of medical malpractice, at least according to him. Mr. Rodriquez, who has been banned from baseball for the 2014 season, claims that a New York Yankees doctor and a prominent New York hospital failed to properly diagnose a torn labrum and cleared him to resume playing, which, he alleges, caused him to suffer additional damage to his hip. The case is in the news most recently as Mr. Rodriguez does not wish to have his upcoming deposition videotaped. http://www.nydailynews.com/sports/i-team/a-rod-filmed-prez-lawyers-article-1.1727500 He claims it would cause unreasonable annoyance, embarrassment and disadvantage. No word on exactly why Mr. Rodriguez should be treated differently than any other person who brings a medical malpractice claim and whose deposition can be videotaped.
Discouraged by years of legislative inaction, a group of California consumers has filed petitions to put California’s caps on medical malpractice awards for non-economic injury on the ballot this year. The caps were enacted in the 1970’s in response to what was claimed to be a medical malpractice insurance crisis. They limit non-economic damages to $250,000. If your child is killed by a medical error, your only damages are non-economic and $250,000 is the most you can get. Regardless of what may or may not have been the merit of capping these damages in the 1970’s, the amount has not been raised in 40 years and $250,000 doesn’t buy what it used to when the caps were put in place. Senator Barbara Boxer of California recently announced her support for raising the caps. All the usual warriors are involved in this battle so be sure to stay tuned.
An article in the April issue of The American Journal of Clinical Pathology reports some disturbing news. When pathology trainees and pathology faculty in Texas were presented with 10 actual closed cases of medical malpractice involving pathology issues, fully half of the respondents were unable to recognize the existence of malpractice. On top of that, they were unable to successfully predict what conduct the juries would identify as malpractice and what they would not. If pathologists cannot agree what constitutes good practice of pathology, we should be concerned about the accuracy of their interpretations.
Last week the Florida Supreme Court declared that the state’s caps on non-economic damages in medical malpractice cases were unconstitutional. The Court held that the caps violated the equal protection clause in the Florida state constitution. The caps were enacted in 2003 in the hope that they would keep down malpractice verdicts and make malpractice insurance more affordable for the state’s doctors. Whether caps achieve that goal has been a hotly debated issue across the country with little good proof that they do. In any event, they won’t be available in Florida barring a change in the state’s constitution.
Here is something refreshing. It is an article by a physician pointing out how payments for medical malpractice have been decreasing for years as have the costs of malpractice insurance. He concludes that whatever may be responsible for the dramatic rise in the cost of health care in this country, it isn’t lawyers pushing frivolous malpractice suits. http://www.huffingtonpost.com/david-belk/medical-malpractice-costs_b_4171189.html
Medical malpractice comes in many forms. A story today from Mississippi highlights this fact. Hospice officials called the coroner to tell him that an elderly man in their care had passed away. Employees of the coroner’s office came, placed the body in a bag, and removed it to the coroner’s office. In the embalming room at the coroner’s office, someone observed that the bag was moving and it looked like the deceased was kicking against it. Lo and behold, the man was still alive. The moral of the story is just because someone tells you that you are dead, doesn’t necessarily make it so. Get a second opinion.
The use of CT scans has exploded over the past 15 years. CT scans provide more information to doctors than do regular x-rays but at a price. Not only are they more expensive than plain film x-rays, they deliver up to 100 times the amount of radiation that a regular x-ray does. Studies have shown that this additional radiation, especially when directed to the abdominal and pelvic areas, produces an increased number of cancer cases. More and more often doctors are being urged to avoid ordering a CT scan without considering carefully whether it is truly necessary. Studies suggest that through a careful history and a thorough examination, doctors can distinguish between those patients who need a CT and those in whom it might be helpful but not necessary. Anything doctors can do to reduce the amount of radiation to which their patients are exposed will be helpful.
The next time someone says we should abolish or limit medical malpractice suits, remember these figures: In 1999, the landmark study “To Err Is Human” estimated that up to 98,000 people die in hospitals the United States each year due to medical mistakes. In 1999 this was big news. In 2010, the Office of the Inspector General of the Department of Health and Human Services reported that up to 180,000 patients died each year due to poor hospital care – and this figure was limited to Medicare patients only. Now a study in the Journal of Patient Safety estimates the annual toll of hospital deaths due to avoidable medical mistakes at 210,000 to 440,000 people. If this is true, it makes preventable hospital errors the third leading cause of death in America after heart disease and cancer. Instead of sweeping these unnecessary deaths under the rug and pretending everything is peachy, we ought to be demanding changes to our health care system.
For the second time in a year a hospital has exposed its patients to an incurable disease because it did not properly sterilize the equipment it used in surgery. http://www.cnn.com/2014/02/10/health/north-carolina-creutzfeldt-jakob/ Neurosurgeons at the hospital operated on a patient with a variant of Creutzfeldt-Jakob disease, an incurable and serious neurological condition. In both this case and the previous one, the hospital sterilized the surgical tools which had been used by conventional means. Unfortunately, routine sterilization techniques do not kill the biological material which transmits the disease from person to person. The need for special sterilization procedures when dealing with a known or suspected case of Creutzfeldt-Jakob disease is well-known in the medical community. In the recent North Carolina case, the neurosurgeons knew that the patient upon whom they were operating might have the disease and the surgical equipment used in his surgery should have received the special sterilization treatment but did not. The hospital believes that 18 patients may have been exposed to the disease through use of the contaminated instruments and is in the process of notifying them. Needless to say, this sort of thing just should not happen – ever.
As life expectancies grow and as the cost of medical care continues to spiral up with no leveling off point in sight, it becomes increasingly important to take into account the cost of medical care in retirement planning. A recent round table in the Wall Street Journal’s on line edition provided some food for thought on the subject and is worth a read. http://online.wsj.com/article/SB10001424052970204002304576626661825344084.html
For years we have been told that earlier detection of cancer leads to a better chance for a cure. Now it turns out this may not be true. Recent studies of survival among breast, lung and prostate cancer patients have not shown any longer survival for those who were diagnosed early. Just why these early diagnosis patients are not living longer than those diagnosed later is unclear and is probably a result of how little we really know about cancer. It may simply be that our current tests are not good enough to find cancer when it can still be successfully treated. It may be related to our difficulty in distinguishing between slow growing cancers and those which are fast growing and deadly. It may be something else entirely. In our blog, we discussed the new findings about prostate cancer on September 23 and on October 28 the new findings about lung cancer.
Last year there wasn’t a single fatal airline accident in the developed world. Unlike the airline industry, however, our health care system kills over a hundred thousand people each year. This article argues for transparency about medical errors as a way to reduce injuries arising from medical negligence.
A story from last year in which the author went looking for stories about frivolous malpractice suits. What she found instead was horror story after horror story about our health care system.
An article exploring the myths about malpractice reform and the claims that further limiting patient rights would reduce health care costs.
For all the talk about frivolous suits being the cause of increasing health care costs, the actual forces driving up costs are more closely linked to increasingly sophisticated technology, physicians performing unnecessary procedures and fraud. The Wall Street Journal has been investigating some of the factors driving up costs. Here are a couple of recent articles from the series.
The Institute of Medicine, established by the National Academy of Sciences, to serve as a national adviser on health issues, performed an exhaustive study of the health care system in the United States entitled, “To Err is Human, Building a Safer Health System.” The study was published in November of 1999. It documented the staggering number of deaths which occur each year due to preventable medical errors. Here is a link to the study.
The New England Journal of Medicine, one of the most respected medical journals in the United States, conducted an investigation into closed insurance company files to see if it were true that there were frivolous lawsuits which were taking money from doctors. What they found was quite different. While there were some suits which did not have merit, those suits usually resulted in no payment to the claimant. On the other hand, many patients with valid claims got no payment. Insurance companies fought long and hard against valid claims. The study concluded that claims of a system stricken with frivolous suits were overblown. The authors also concluded that the huge sums spent by insurers in fighting legitimate claims were a burden on the system.
Wall Street Journal report of survey of hospital nurses showing communications errors, medical shortcuts, incompetence and disrespect leading to patient injuries or near misses.
Consumer advocacy group, Public Citizen, reports that state medical boards often fail to take action against doctors who have been disciplined by the hospitals at which they practice. Many of the doctors getting off with no discipline by the state medical board had been sued multiple times for malpractice, including a New Mexico doctor with 26 cases and an Indiana physician with 20.
The Wall Street Journal reports on a survey of hospital nurses showing communication errors, medical shortcuts, incompetence and disrespect lead to patient injuries or near misses.