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.
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. Just wave a magic wand and declare someone who barely got out of high school is now a nurse. 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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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December 23, 2021
A San Diego plastic surgeon and his operating room nurse have been arrested and charged with involuntary manslaughter in the death of a patient who was undergoing a breast augmentation procedure in the doctor’s surgery center. According to prosecutors, the surgery was nearly complete when the patient went into cardiac arrest. Surprisingly, there is no suggestion in the charges that an anesthesiologist was present. Rather than call 911, the surgeon and nurse attempted to resuscitate the patient on their own. They were able to get her heart restarted, but she continued to deteriorate. The surgeon called other doctors for advice and more than one of them told him to call 911. He finally did call 911, but not until three hours after the patient’s heart first stopped. The patient survived for a few more days but never regained consciousness.
There are risks inherent in every surgery. When surgery is performed in an office setting without an anesthesiologist present, the risks are far greater than if the surgery is performed in a hospital operating room with an anesthesiologist present. Seems to me that the minimum you can ask for is that the surgeon call 911 for help when things go wrong. Looks like that is the way the prosecutors view it as well.
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December 22, 2021
Our bodies don’t know it is almost 2022. They think we still live as hunter gatherers did 50,000 years ago. One of the ways that affects us today is that, when we attempt to lose a lot of weight, especially in a short period of time, our bodies react by greatly slowing our base metabolism to keep us from starving to death. Perversely, that lowered base metabolism stays low, even if we regain much of the weight we lost in the first place. Lessons to be learned are to reduce gradually and to combine caloric restriction with exercise. Good luck.
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December 7, 2021
When choosing a hospital, you can add another question to your list: How likely is this hospital to sue me, if I can’t pay the full bill? According to a review of records from Wisconsin by the Wall Street Journal, some hospitals are much more likely to sue their patients than others. This is no small thing. People who are uninsured or who have insurance but high deductibles or co-pays, can find themselves stuck with high hospital bills and no way to pay. While most people are willing to try and work something out with the hospital and pay the bill over time, a hospital that uses lawsuits against its patients can ruin credit and make life very hard for those patients. Do yourself a favor, even if you have insurance, see if the hospital you are thinking about using is suit happy or not.
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December 6, 2021
What’s in a name? Plenty, apparently. Physician Assistants claim that they get n0 respect because people figure they are nothing more than glorified nurses. They want to change their title to Physician Associate. That does not sit well with physicians, who claim that this will mislead the public into thinking that the Physician Associates are just junior doctors. This turf battle will undoubtedly go on for some time. Wake me when it is over.
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December 3, 2021
I recently blogged about the practice effect for surgeons and how powerful it is. Here is a link. A recent story in U.S. News and World Report confirms the effect and its size. One statistic that struck me was that “routine” knee replacement procedures had a 24 times greater risk of death when performed at a rural Colorado hospital with 25 beds than the national average. The risk of death from hip replacements was three times as great.
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December 2, 2021
Beware the scammers. They are seemingly everywhere trying to steal your money and your data. One of the more common scams at this time of the year centers around Medicare’s open enrollment period. Scammers sign Medicare beneficiaries up for Medicare Advantage plans without their knowledge or consent and then get commissions for doing so. Or scammers get your Medicare number and charge Medicare for treatment you never received. Don’t give out your personal information to anyone. Scammers can make it appear that the call or text you are receiving is coming from Medicare or from your local hospital or from your doctor. Don’t fall for it. Before giving out any data, hang up and call back at a number you have looked up yourself. It takes all of us to keep the scammers in check.
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December 1, 2021
Another reason to get the COVID vaccine, if you need one. According to all the research, as we age, we lose some of our ability to smell things. More than half of all adults 65 to 80 have some degree of olfactory dysfunction. Researchers are not sure exactly why this happens, and it is probably multi-factorial, but it gets worse as we get older. One thing they know does make it worse is a COVID infection. According to new research, 1.6 million Americans have chronic smell problems due to COVID and it is worse among those who are older and who may have had some declines in this area even before they got COVID. Save your life and maybe even your sense of smell – get vaccinated and then get boosted.
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November 30, 2021
Using a process they call “bar coding” scientists are learning new lessons about the behavior of cells in the body. The bar coding allows them to label a cell. Once it is labeled, all of its descendants will carry the same label. Using this method, which is only a few years old, they have already figured out why some cancer treatments work and why some don’t. The answer lies in the fact that the cells scientists believed were the sources of cancer and to which they directed chemotherapy were not in fact the source at all. The source was other cells, which were unaffected by the chemotherapy. Although bar coding of cells has not resulted in any new treatments yet, the increased understanding it is permitting will lead to new and more effective treatments for cancer and other diseases.
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November 24, 2021
Hallelujah! It looks as though, after many, many years of diabetics being at the mercy of the big drug companies and their never ending price increases for insulin that Congress is going to pass legislation to cap insulin costs. The exact form this will take is still being debated but it appears this will finally get done. Congratulations to all those who worked so hard and for so long to make this happen.
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November 17, 2021
Big Pharma is flexing its muscles again, this time over the possibility that Congress will allow the federal government to negotiate the price Medicare pays for prescription drugs. On the way in to work this morning, I heard a radio spot in which a couple was lamenting that, if Congress permitted price negotiation, the drug companies would not have enough money for research into new wonder drugs and how awful that would be. Trust me, the sky is not falling, if Medicare gets to negotiate drug prices. We pay more for the same drugs than any other country in the world. It is time to get past the drug industry’s scare tactics and let the market establish fair prices for drugs. Why is Big Pharma afraid of fair prices?
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November 15, 2921
Medicare beneficiaries are about to experience the largest premium increase in program history. About half of the increase is due to the approval of a very pricy and controversial Alzheimer’s drug. The new drug is controversial because it does not cure Alzheimer’s. At best is slows it progression and yet it costs almost $60,000 per year to treat a patient. This once again highlights the abject failure of Congress to allow Medicare to negotiate drug prices with the manufacturers. Seniors are at the mercy of Big Pharma. When it chooses to raise prices, Medicare beneficiaries must either pay up or do without.
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October 28, 2021
Here is another one, this one close to home. A doctor, who maintained what he called a mobile practice in Phoenix and Tucson, has been indicted for Medicare fraud. The allegations are the usual ones: billing for more services than were delivered, billing for services not provided, claiming a higher degree of complexity than the procedure justified. He is accused of billing Medicare for $33,000,000 of services. That sure seems like a lot and you have to wonder how he was able to escape detection long enough to bill that amount. I wish they were a little more vigilant.
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October 25, 2021
Something is going on with younger women and pancreatic cancer. More and more younger women, especially between the ages of 15 and 34, are developing pancreatic cancer. The disease used to be more prevalent in men, but, if the current trends continue, women will have a much higher incidence than men in the not too distant future. Medical researchers are at a loss to explain why the rates for women are on the increase. Likely, there is something in the environment to which they are exposed and to which men are not.
The prognosis for pancreatic cancer patients is poor because the disease is usually discovered late in its development when surgery is no longer a viable option. The five year survival rate for pancreatic cancer patients is only 10%. That survival rate has barely budged over the last 20 years, despite the advancements in the treatment of other cancers. All of this points up the need to identify patients with pancreatic cancer earlier than we are able to do now. Genomic testing may provide a tool for early detection. Time will tell.
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October 21, 2021
Privatization is the practice of using a private company to deliver services that would otherwise be delivered by the government. It is very popular with some politicians, who claim that private business is more efficient than the state so that taxpayers get more for their money. Sadly, it doesn’t always work out that way. The latest example of privatization failing to deliver comes from Iowa.
A few years ago, the governor privatized Iowa’s Medicaid program. It had been run by the state and would now be run by two private companies. After many complaints, the state auditor conducted an investigation, which showed that the two companies were improperly denying many Iowans the benefits to which they were entitled and were breaching their agreements with the state. Predictably, the companies say the state auditor just doesn’t understand how these things work. Unsurprisingly, it looks like our old friend money may be playing a role in the coverage denials by the private companies, which are still being paid for the care they are refusing to provide.
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October 18, 2021
More evidence that our bodies were evolved to live in a certain environment and do not do well when taken out of that environment: Chemical tests have detected markers of brain damage in blood samples taken from astronauts returning from months in orbit in the international space station. The numbers of tests are small, of course, and the researchers admit there could be many reasons for the damage. It could be the result of prolonged weightlessness, the stresses of launch and recovery, or changes in brain fluid. The concern is that we cannot send people on long term missions in space until we understand the causes of brain damage and have a plan to address them.
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October 14, 2021
Still another story in the news about a doctor misusing his position to gratify his sexual desires. This one in New York City. He abused women, some by addicting them to drugs and then trading drugs for sex. His hospitals allowed him to be in examining rooms alone with his female patients. When he would finally be caught at one hospital, he was allowed to move on to another without the new hospital being told that he was a predator. One more example of how the medical profession does a lousy job of policing itself. When are we going to wise up and make some changes?
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October 12, 2021
Doctors are rethinking the prescription of low dose aspirin to men and women below 60 who are at risk of having a heart attack but have not had one yet. The latest research suggests that the risks associated with long-term use of even low dose aspirin in this group outweighs the benefits in preventing heart attacks. For that reason, this group should no longer take low dose aspirin on a regular basis as a prophylactic. This does not change the recommendations for older patients who have had a heart attack in the past. Their physicians may still prescribe daily low dose aspirin.
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October 6, 2021
It seems as though every time you turn around there is another story in the news about a predatory doctor abusing his (why are they always men?) patients while those who were supposed to be protecting the public were looking the other way. The most recent story involves a pediatrician employed by the Indian Health Service to provide medical care to Native American children on reservations in Montana and South Dakota. This doctor worked for the Service for thirty years. During that time there were numerous complaints about him abusing young, male patients. Despite these complaints, senior employees of the service failed to document or investigate them. There is even evidence that whistleblowers who complained about the doctor were punished. For whatever good it does his victims, the doctor is now serving five life terms in prison. Can we please get someone to take seriously their responsibilities to the public?
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October 5, 2021
Car makers and appliance makers are not the only manufacturers whose businesses are being affected by the shortage of computer chips. Makers of medical devices also rely on the availability of chips in the creation of their products. MRI machines, monitors, EKG machines, diabetes blood testing devices and many, many more need computer chips to operate. While the public can probably afford to wait for the new car or the new dishwasher, a shortage of medical equipment can be critical and life-threatening. Manufacturers of medical devices have taken to going directly to chip manufacturers and suppliers and asking for priority in getting the chips they need. So far, it appears chip suppliers have been sympathetic but delays and price spikes are a continuing problem.
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October 4, 2021
As if we needed more proof that our system of pricing hospital services is broken. In today’s Wall Street Journal there is an article about how wildly different are the charges for treating Covid patients even in the same hospital. The hospital was New York-Presbyterian Weill Cornell Medical Center. For a similarly situated severe respiratory distress patient, the hospital charged patients insured by Aetna around $55,000. If the patient was insured by United Healthcare, the hospital charged around $64,000. If the patient was insured by Anthem’s Blue Cross Blue Shield, on the other hand, the charge was nearly $95,000. If you think this makes no sense, you are right.
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September 28, 2021
Humans are not the only ones who are being put in harm’s way by the ability of bacteria, viruses, and other dangerous organisms to evolve so as to defeat existing medical treatment. Poor Fido is in the same boat. Hookworms are a common parasite in dogs. They have now evolved to the point that the existing drug therapies are no longer effective. A large part of the blame is being placed on dog parks, where dogs can be infected over and over with hookworms who have survived attempts to kill them. Hookworms are also a threat to humans. They can penetrate the skin and cause itchy, red rashes. Many vets recommend keeping your dog away from the dog park.
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September 21, 2021
Here is a link to the first part of a two part story on CBS News about medical boards failing to protect the public by failing to discipline bad doctors. The story focuses on an OB/GYN, who also performs plastic surgery procedures. When a prospective patient looked him up on the web site of the California Medical Board, there was no record of discipline or problems, even though he had been previously disciplined for poor care and for having a sexual relationship with a patient. Although the doctor now is under a multi-count indictment for fraudulent billing, his medical license in California remains active as the board investigates him. The moral of the story is that medical boards often care more about what happens to the doctor than they do about what happens to the patient.
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September 15, 2021
You didn’t think it was going to be easy, did you. When the Biden administration proposed allowing Medicare and other government programs to negotiate with drug manufacturers about price, it had the potential to save the taxpayers hundreds of millions of dollars. Of course, those savings would come at the expense of the drug manufacturers, who charge higher prices in the United States than anywhere else in the world. Well, all those lobbying dollars spent by the drug industry and all the political contributions made by it, are having their intended effect now. Some Democrats are joining all the Republicans in opposing the planned changes. This isn’t over yet, but it once again looks good for the drug companies. They tend to get what they pay for. Keep an eye on this story.
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August 30, 2021
Even before the onset of the Coronavirus pandemic, there was a shortage of nurses in the United States. Since the pandemic began in earnest, that shortage has grown only worse. Not only do we need more skilled nurses to care for those becoming very sick due to the virus, many of the nurses who were working at the beginning of 2020 have left the profession due to age, illness or just plain, old burnout. This has big implications for everyone.
For one thing it means that when you go to the hospital, there may not be a skilled and experienced nurse there to care for you. Staff shortages are forcing more hospitals to place less-skilled, less-experienced nurses on the front lines. Staff shortages also mean that nurses are working longer shifts to care for the patients who are in the hospital. It also means that many shifts don’t have all the nurses they need to care for the patients they do have. All of this adds up to more mistakes in patient care due to inexperience, inadequate supervision, fatigue and just not enough nurses to meet the needs of patients.
Be careful out there. This problem is not going to be solved for a long, long time.
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August 25, 2021
As if anyone should need more evidence that our health care delivery system is broken, here is an excellent article from the New York Times analyzing some of the price data that hospitals are being required to make available. You may recall that hospitals fought this disclosure requirement tooth and nail for decades. Now that they have lost, some hospitals just refuse to comply and have not posted the information or have made it extremely hard to find. Analyses like the one in the Times’ article shows why they continue to try and hide this information.
There is no rhyme or reason for why hospitals charge wildly different amounts for the exact same procedure. Health insurance companies negotiate rates with hospitals. Sometimes they have little incentive to get the best deal since they get paid a percent of the billings. In that case, high billings equal higher pay for the insurance company. In some instances, people with no insurance get charged less for a procedure than those with insurance. In some cases, hospitals charge the same insurer different prices depending on who the insured is or which of the insurer’s plans is involved. This makes a big difference for people with insurance, as they are being forced more and more often into plans with high deductibles and high co-pays.
Don’t let hospitals continue to get away with playing hide the ball when it comes to what they charge. Insist that they disclose their rates as required by law.
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August 18, 2021
As with many other things in medicine, there is a lot of money to be made from orthopedic devices, the hardware orthopedic surgeons place in our bodies. They run the gamut from artificial hip joints, to knees, to plates and screws. Here is a link to one of a series of stories from the Kaiser Health Network on abuses involving these devices. According to the article, manufacturer’s representatives sometimes pressure surgeons to implant devices that are the wrong size or are defective. It is worth a read.
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August 11, 2021
More on orthopedic surgeons who own stock or are otherwise paid by companies that manufacture or distribute the hardware spine surgeons put in patients. “Whistleblowers and government fraud fighters have argued for years that money passing from industry to doctors can corrupt medical judgment, inflate costs and lead to unnecessary operations or otherwise harm patients.” See more at Kaiser Health news.
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August 4, 2021
More and more evidence is accumulating that sleep apnea is bad and can kill. As we become older and heavier, the incidence of sleep apnea increases. The tissue in the airway relaxes and blocks the airway as we sleep. Our body, deprived of oxygen, wakes us suddenly gasping for air. Once we have increased our oxygen levels, we fall back asleep and the pattern repeats over and over again throughout the night. In addition to being linked to a whole host of medical problems, the latest research suggests that those with untreated sleep apnea have a significantly increased risk of sudden death. While not all with obstructive sleep apnea snore, most do. If you snore, you should consider if you have sleep apnea and get tested.
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August 2, 2021
A few weeks ago I blogged about the coming genomic revolution. One of the specific goals of the researchers in this area was the ability to test for the presence of cancer by simply analyzing a drop of blood. Well, last week some of the biggest hitters in the medical research industry revealed their new company that claims to be able to do just that. The new company is Grail, as in Holy Grail, and its offering is called Galleri. It claims that the test can detect the presence of more than 50 types of cancers and also identify the organ which developed the cancer. Among the heavy hitters associated with this offering are AstraZeneca, Amgen and Bristol Myers Squibb. Watch this space. Lots more of this to come.
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July 22, 2021
I have written on many occasions about the benefits of an active lifestyle. Moving around is what we were made to do and it is good for us. Study after study has shown that being active confers benefits to nearly all parts of our bodies.
Researchers have wondered if the same benefits come from weight or resistance training. Turns out there are significant benefits but they are different. When the muscles are stressed by weight training or resistance training, they send messages to the fat cells telling them that it is time to turn some of that fat to energy. And we all want to lose some of that fat, don’t we?
Bottom line is that, in addition to whatever activity you choose to raise your heart rate and keep your body moving, it would be helpful to add some weight training. It can be as simple as pushups, or squats or using resistance bands. Give it a try.
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July 20, 2021
Hospitals across the country continue to resist the rule requiring them to post their pricing data so that it can be reviewed and evaluated by the public. The idea is that, if a patient knows how much it will cost to get a certain treatment at a hospital, she can compare that cost to the same treatment at a neighboring hospital and perhaps choose the lower price. This will theoretically spur competition. Without price data, there is no way patients can comparison shop.
Surveys have shown that 32% of hospitals and hospital chains do not post usable price data on their web sites, despite the federal rule requiring them to do so. Many post the data but insert code into their web pages that prevent Google and other search engines from finding and displaying it. Another 10% post some data but fall short of the price data required by the rule. That means that close to half of all hospitals in the country are violating the rule.
The federal government is cracking down on these scofflaws by increasing the penalties for failing to comply. Hospitals with over 30 beds can now be subject to a fine of $2M annually for failing to comply with the rules. Let’s see if that gets their attention.
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July 19, 2021
I wrote about the San Diego doctor who was selling Covid-19 “cure” packages for big money. He billed the treatment kits as “magic bullets” and “miracle cures.” He just pleaded guilty to attempting to smuggle hydroxychloroquine into the country for use in his “cure” packages, to misleading the public and to lying to the FBI when it came to investigate. He will be sentenced in a few months.
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June 29, 2021
Good news, coffee drinkers. Drinking any type of coffee significantly reduces the risk of getting nearly any type of liver disease from cirrhosis to liver cancer. Three to four cups a day seemed to produce the greatest protective effect. Although all kinds of coffee were valuable in decreasing the risk of liver disease, coffee made from ground beans was the most effective.
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June 28, 2021
Here is the latest example of our broken health care billing system. Like airlines, hospitals break treatment down into as many individual tasks as they can manage with a straight face and then bill separately for each one. The lucky recipient here was a young woman, who went to the emergency department with excruciating lower abdominal pain, which she was afraid might be appendicitis. At the hospital, she had an IV line placed. One CT scan and two doses of morphine later, it was determined that she did not have appendicitis and that the pain was most likely the product of a ruptured ovarian cyst. Good news: ruptured ovarian cysts are typically not a cause for concern and she was allowed to go home. Bad news: when the bill came, the young woman found that the hospital had billed her for each of the two times the nurse had injected morphine into her IV line. The process takes a matter of seconds. It is often even quicker than giving a shot into the arm. Each time, the hospital billed the young woman $700 for a total of $1,400 for maybe 30 seconds of nursing time. There ought to be a law against this kind of insanity.
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June 18, 2021
The Centers for Disease Control is looking into reports that over 100 patients who underwent orthopedic surgery using a contaminated bone putty have developed tuberculosis from the contamination. The manufacturer has recalled the product but that is of little help to the poor people who developed TB.
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June 15, 2021
Interesting story on the Kaiser Health News platform about start ups, and even Amazon, trying to make money by delivering primary care over the phone or the internet. Lots of room for these companies to grow and to save money for patients and for the employers who pay for their insurance.
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June 4, 2021
Perhaps you have read about the fake reviews that appear on travel sites for hotels and restaurants. Those fake reviews also follow the money in health care where a fake review may cost you more than just the price of a bad meal. Glowing reviews and recommendations by “patients” on a doctor or hospital’s web site may not be real. Here is a link to a story in today’s Washington Post on the topic. There is a thriving business in selling fake reviews.
There is also little enforcement against those who sell the fake reviews or those who buy them. You have every right to be skeptical about Google and Yelp reviews and ratings.
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June 3, 2021
“Antibiotic stewardship” is the latest step being taken to reduce our society-wide overuse of antibiotics. “Antibiotic stewardship” is a program intended to make doctors more mindful of the overuse of antibiotics and of the steps they can take to reduce that overuse. The CDC now recommends, for example, that when a patient has a bacterial respiratory infection, and the doctor writes a prescription, she should accompany it with the direction to wait a few days to fill it to see if the patient gets better without the antibiotic. Often they will get better on their own and the prescription will never be filled.
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June 2, 2021
Our system of drug pricing is so broken. Many insurance plans which cover drugs hire pharmacy benefit managers to negotiate drug prices for them. These managers take a cut. Drug manufacturers blame high drug prices on these middlemen. The middlemen blame high drug prices on the drug manufacturers. Even more troubling, these middlemen apparently get less than the best deal for the insurance plan’s customers. According to a recent article in the Wall Street Journal, 30% of the time an insured person fills a prescription, she or he would have gotten a lower price from the pharmacy had they paid cash for their prescription and not used their insurance at all. The takeaway is to always ask the pharmacist if you can save money by paying cash.
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May 28, 2021
Story today in the Wall Street Journal about the many scammers out trying to make money on the Covid pandemic. Medicare is a big target. According to the story, many scammers are billing Medicare for Covid tests and treatments that were never done, often billing into the millions. Scammer motto: “Never let a good crisis go to waste.”
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May 19, 2021
From the health news writer at the New York Times on growing older:
“Without regular exercise, you can expect to experience a loss of muscle strength and endurance, coordination and balance, flexibility and mobility, bone strength and cardiovascular and respiratory function. In other words, a sedentary lifestyle is a recipe for chronic disease and decline.”
May 18, 2021
Over a year after hospitals were required to display their prices for services in an easy to find and easy to understand place on their web sites, many still play games and refuse to do so. According to a recent survey, half weren’t doing it at all and many of the other half were publishing their prices in a way that the general public could not understand. If you expected more from America’s hospitals, you have not been paying attention.
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May 14, 2021
Covid-19 is the gift that keeps on giving. In addition to all the other woe and heartache it has caused, it apparently is also responsible for a spike in alcohol related hospitalizations. Many people turned to alcohol to alleviate their feelings of anxiety or out of boredom during the pandemic. Now many of them are experiencing gastrointestinal or liver issues from drinking too much. Let’s hope things get better soon.
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May 11, 2021
Chalk up another win for the Mediterranean diet. Not only is it the best diet for heart health and for weight loss, there is now evidence that it prevents the build up of proteins in the brain that cause Alzheimer’s. Pretty impressive for pretty simple and pretty good tasting diet.
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May 10, 2021
Our old friends at Big Pharma are back at it. Actually, they never left but have increased their lobbying efforts in Washington. According to an article in the Washington Post, the pharmaceutical industry is on track to spend more money lobbying this year than it has ever spent in the past. There are now more than two registered pharmaceutical and health care product lobbyists for every member of Congress. No other industry comes close to the pharmaceutical industry when it comes to spending money to lobby Congress. The industry makes huge profits and is willing to spend big on lobbying to keep it that way.
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May 6, 2021
This week’s blog post was about the sale of continuous glucose monitors (CGM’s) to people with Type 2 diabetes. An article in a recent edition of the Wall Street Journal discussed the use of CGM’s by people who don’t have diabetes at all. These folks are health conscious people who just want to keep tabs on their blood glucose levels. One problem for these techies is that you still need a doctor’s prescription and just keeping tabs on your blood sugars when you don’t have diabetes is a problem for many doctors, who refuse to write prescriptions.
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May 3, 2021
According to a report by Kaiser Health News, CVS and Walgreens have combined to waste more doses of Covid-19 vaccine that all the states and the federal government combined.
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April 29, 2021
Lifestyles of the parents, both mother and father, likely affect health of their children in later life. Greasy diets and obesity by either parent = bad. Healthy diets by both parents and exercise by mom during pregnancy = good.
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April 28, 2021
Researchers who study scarring in humans have found that the injection of a drug now used to prevent macular degeneration can prevent scar formation in mice and pigs. The skin of pigs is very similar to that of humans and human trials are now underway. The results are very promising. Keep your fingers crossed.
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April 22, 2021
A chiropractor was sentenced to nine years in prison for a large and sophisticated scheme to defraud medicare and health insurance companies. The scheme involved hiring medical doctors to pretend to be the owners of his clinics, billing for services which were never provided or which were medically unnecessary. In these types of schemes, it is not just the defrauded payers who are hurt; patients are hurt as well.
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April 21, 2021
Recent research with mice presents some strong evidence that icing muscles after a hard workout or after an injury does not speed healing and, in fact, may delay it. The study of the muscles of mice that had been exercised hard showed a pattern of inflammation which cleaned up and disposed of damaged cells. This was followed by a quieting process which ended the inflammation and rebuilt the damaged tissue. Return to full and strong function was slower in the mice whose muscles were iced and who delayed and reduced the inflammation. Once again, maybe Mother Nature knows best.
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April 20, 2021
The importance of getting a good night’s sleep is being highlighted by recent medical research into the risk of dementia. The most recent study shows that getting less than 6 hours of sleep at night during a person’s 50’s is associated with a 30% increase in the risk of dementia in later life. Researchers think that sleep allows the brain to dispose of the toxic proteins that eventually lead to dementia. If a person does not get enough sleep, it allows these toxic proteins to build up in the brain. The presence of these proteins is thought to be a cause of dementia.
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April 12, 2021
According to this article by Kaiser Health News, America’s largest hospital systems received the lion’s share of the federal Covid bailout money and many had banner years as a result. Small hospitals, got less and limped along.
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April 9, 2021
Finally, some unalloyed good news. Drinking cocoa, as well as green tea, may improve blood vessel function and lower blood pressure, thereby protecting the blood vessels of those who are susceptible to mental stress. Any food having high levels of flavanoids, such as apples, blackberries, pears, black grapes and cherries, will have the same effect.
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April 5, 2021
Here is a link to the page of the Arizona Medical Board which identifies the 81 medical doctors who were the subject of board action in the last year. It makes for some interesting reading. See what your medical board has been doing and to whom and for what reasons.
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April 1, 2021
Not an April Fool prank. Scammers are not just preying on you and me. According to the Arizona Medical Board, scammers are calling doctor’s offices and making the caller ID look like the call is coming from the Medical Board. They may allege that opioids have been found and tied to the doctor. The scammers then try to get personal identity information or a transfer of money. It is important that all of us be aware of scammers and be careful not to click on unsolicited links and not to disclose passwords or other confidential information unless you are sure of the person asking for it.
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March 31, 2021
Another entry for the “use it or lose it” file. For many years, researchers have known that exercise can improve blood flow to the brains of older people. Good blood flow to the brain is essential to good brain health and the development of new neurons. A new study shows that a little brisk exercise can actually improve memory and executive brain function in older adults who are already beginning to experience some cognitive decline. The exercise reverses the process to a degree. Get up off that couch and get moving.
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March 30, 2021
A recent study found that black patients were more likely to be treated at lower quality hospitals than white patients with similar illnesses or medical conditions. As a result, black patients were more likely to be injured while in the hospital or to have a poor outcome. Being admitted to a high quality hospital made a big difference in safety outcomes, according to the study. The study did not examine why black patients were admitted more often to lower quality hospitals.
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March 29, 2021
There is some bad news and some good news today for the carnivores among us. The bad news is that eating even a small amount of processed meats increases a person’s risk of developing dementia. The surprising good news is that red meat, which has not been processed, may offer some protection against dementia. Strange indeed.
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March 26, 2021
Where there is money, there are fraudsters. I have warned about Covid fraudsters in the past. Here is a link to a story about the Justice Department’s cases against the Covid fraudsters they have been able to identify so far. They have brought charges against 474 individuals who have attempted to steal over $569,000,000 in your tax money. There are certainly lots more out there that have not been caught yet.
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March 23, 2021
There is still so much to learn about the Coronavirus. The most interesting story I saw today came from of study in Denmark. It found that most people who recover from a bout of Covid have immunity for about six months. This is not true, however, for victims over 60, who are much more likely to be reinfected. Even if a Covid survivor is reinfected, the reinfection is likely to be affected by the residual immune reaction and be mild or even asymptomatic. The fact that natural immunity is not that strong or that long-lasting reinforces the need for everyone, even those who have already had Covid, to be vaccinated.
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March 22, 2021
New research suggests that eating breakfast before 8:30 a.m. reduces the risk of Type 2 diabetes. The research did not consider what was eaten but it is assumed that a healthy breakfast is even better if eaten before 8:30 a.m.
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March 19, 2021
Are you feeding your gut bacteria properly? This question has been raised by researchers who have found that older people with the greatest change in their gut biome are the healthiest and tend to live the longest. They believe that complex carbohydrates found in fruits, vegetables and nuts provide the nutrition needed for your gut bacteria to continue to do their jobs as you age. Stay away from processed foods to the extent you can.
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March 18, 2021
We are barely halfway through the month of March and already the Department of Justice web site related to Medicare fraud cases has publicized fraud complaints, indictments, guilty pleas and convictions involving a total of over $400,000,000 in fraudulent billings.
As astonishing as these numbers may be, there are two things to keep in mind. 1) Many of the government press releases do not mention the amount of the alleged fraud, so there is lots more where that came from. 2) The government catches only a fraction of those who steal from the Medicare program.
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March 17, 2021
In 2015, Pfizer took over operation of a drug manufacturing plant after acquiring its then owner. The plant at the time of the acquisition had a bad history of mold contamination, which apparently has continued despite FDA inspections. While this kind of contamination is always of concern, this plant is being used to manufacture Pfizer’s Covid vaccine, which places the FDA in a tight spot since it does not want to shut down vaccine production. Here is a link to a story about the plant.
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March 16, 2021
They are definitely out there. A south Florida woman was recently arrested for performing plastic surgery on a man without going through the lengthy and expensive requirement of attending medical school. It is highly unlikely this was her first and only “patient.” Remember, just because someone says they are a doctor does not mean that they are in fact a doctor. Be careful about whom you let touch your body much less perform surgery on it. Not surprisingly, the plastic surgery did not go well.
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March 10, 2021
Here is a link to a New York Times story illustrating the insanity of our patchwork health insurance and healthcare system. This gentleman went to the hospital with possible coronavirus just before he became eligible for Medicare and just after he had cancelled his other health insurance coverage. Because the doctors were not sure he had coronavirus, they did not diagnose him with it so he was not eligible for a fund for coronavirus patients. He makes just a little too much to be eligible for other programs which assist the poor. He is now saddled with a bill for over $22,000.00, which the hospital is threatening to send to collections. As one person observed, it is crazy that your diagnosis can make the difference between a bill being paid and one which sends you into bankruptcy. We need to do a better job providing health care and health insurance to our citizens at affordable prices.
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March 6, 2021
State prosecutors in New York have taken the unusual step of charging a medical doctor with the second degree murder of five of his patients. The charges were based on the allegation that the doctor prescribed large amounts of opioid medications to patients, who were struggling with addiction issues. He was also charged with recklessly endangering another eleven patients through the same behavior. This is one of the first cases ever to charge a licensed physician with murder in connection with the prescription of opioids. The doctor, 75, no longer practices medicine, having turned in his license in 2019.
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March 5, 2021
Add this to the “Keep it moving” file. A study of sedentary African-Americans in their 60’s found that even a little bit of regular aerobic exercise improved brain function and memory. The brains started acting like they were much younger. Among the many takeaways, it is never too late to start being more active.
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March 2, 2021
Confused about which vaccine to choose? Don’t be. Often you won’t have a choice anyway. What you get will depend on where you are getting your shot(s) and from whom. Best advice appears to be that when offered the opportunity to get a vaccine shot, take it and don’t worry about which vaccine it is.
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March 1, 2021
Here is a good story about how diets high in fructose can damage the immune system by increasing inflammation. Fructose, a natural form of sugar, is found in many fruits and some vegetables. A sensible diet including these foods is healthy. The problem occurs when we eat too much fructose. Many products we see on the supermarket shelves have added sugars. We should stay away from those as much as possible.
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February 24, 2021
I have written a couple of pieces on sepsis and the novel treatments being tried to derail this deadly condition. Recently there had been a lot of buzz about the possibility of Vitamin C along with some other vitamins and steroids as a treatment. While there had been some early promise, a large study failed to show any consistent, positive effect. The researchers who originally reported good results are going back to the drawing board in an attempt to figure out why things looked good at first and if there is still a role for Vitamin C in the treatment of sepsis.
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February 4, 2021
By coincidence, CNN has a story up about how to avoid Covid-19 vaccine scams. Markers of vaccine scams are offers to help you cut the line to gain a priority, requests that you pay for the vaccine, requests for personal information to register you for the vaccine, offers to ship the vaccine to you for a price, and insisting that you take additional tests before being vaccinated. Be careful out there.
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February 3, 2021
Although it took no particular skill to do so, I correctly predicted fraudsters would be out in force to take advantage of the Covid-19 pandemic. What I did not foresee, but perhaps should have, was that elected officials would get in on the act too. The feds have indicted a Missouri state legislator for fraud in the marketing of stem cell treatment for Covid-19 in her health clinic. The fluid she claimed contained stem cells, contained no such thing. In the great tradition of snake oil salespeople everywhere, she marketed the “stem cell” treatments as good for whatever ails you from Chronic Obstructive Pulmonary Disease to erectile dysfunction. The treatments were pricey too. Keep your eyes open and one hand on your wallet whenever you are around politicians.
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February 2, 2021
Artificial intelligence continues to make contributions to science and to medicine. The latest news is the use of AI to predict which people with normal cognition will develop Alzheimer’s disease in the future. The experiment involved people who did not have Alzheimer’s. They were asked to describe the scene in a drawing they were shown of a boy reaching for a cookie while his mother dried dishes and the sink overflowed. The computer was able to detect subtle differences in sentence formation on the part of participants who five or ten years later developed Alzheimer’s. The ability to predict the development of Alzheimer’s will allow physicians to direct treatment toward these patients which may delay the onset of symptoms.
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January 12, 2021
Finally, the Covid vaccinations have begun for front-line health care workers and residents of nursing homes. Close behind are teachers, law enforcement and those over 75. There is still so much to learn about the vaccines and their effects. One of the questions addressed by today’s Wall Street Journal was whether vaccinated people can still spread the virus. The answer, unsurprisingly, is that no one knows. For that reason, medical experts are urging that even those who have been vaccinated continue to wear masks, socially distance and wash their hands well and frequently until we reach herd immunity and the virus dies out. When we will reach herd immunity, if ever, is also an open question. Welcome to the new normal.
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December 29, 2020
To the list of questions you may want to ask your surgeon before scheduling surgery, add this. “What is your birthday?” Analysis of data relating to Medicare patients shows that surgeries performed on the surgeon’s birthday have a higher rate of complications. Although there is no way to know for sure, the supposition is that the surgeon is more likely to be distracted by outside events on his or her birthday.
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December 28, 2020
2020 is on track to be the deadliest year in the history of our country. Deaths are expected to exceed 2019 totals by over 400,000, primarily due to the Covid pandemic.
Stay safe. If you become ill and need to go to the hospital, there may be no room for you. Don’t take a chance.
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December 4, 2020
Here is a follow up to yesterday’s post. Europol, the police agency of the European Union, is warning that organized crime rings are going to be selling counterfeit Coronavirus vaccines. Make sure you get yours from a source you trust. Probably better to get it from a large chain than from an individual doctor. Harder for criminals to trick a large chain than to trick an individual doctor.
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December 3, 2020
As I have observed on many occasions in the past, where there is an opportunity, there will be scammers attempting to separate honest citizens from their cash. Such an opportunity is almost upon us in the form of the Covid-19 vaccines. The federal government is already sounding the alarm. There will be scammers offering to put you or your family at the head of the line for vaccination. There will be scammers offering you “genuine,” government-approved vaccines. Who knows what else they will offer, but it will all be based on limited supplies and fear of illness. Be on your guard.
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December 1, 2020
High test volumes for the Covid-19 virus have highlighted a problem that has always existed but which most people never really considered. Test results are often wrong. There can be false negatives or false positives. Some tests have a much higher error rate than others. Treatment can be initiated on the basis of an erroneous result or can be withheld. As always, be proactive about your health. Don’t rely on test always being accurate. Get second tests and get second opinions.
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November 23, 2020
A Mississippi doctor on trial in federal court for his alleged role in a health insurance fraud scheme has been acquitted on most of the charges against him. The jury deadlocked on the last one. The doctor was accused of writing unnecessary prescriptions for expensive compounded medicines in return for kickbacks from the pharmacies that prepared the medicines and delivered the prescriptions. The doctor contended his signature on the many prescriptions was a forgery. Guess the jury bought it. The scheme is a real one and a number of participants have already pleaded guilty.
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November 17, 2020
Medical researchers are reporting what they refer to as a “breakthrough” in the understanding of Covid infections. One of the major mysteries of Covid infections has been why some people do so much worse than others. Researchers have discovered that many male patients who developed life-threatening infections have autoimmune antibodies, which disable key immune system proteins called interferons. More study is needed but if this finding is supported by more research, interferon therapy to replace the disabled proteins may be a significant form of treatment. Stay tuned.
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November 10, 2020
I have warned in the past about doctors, or those who claim to be doctors, taking advantage of the Covid pandemic to fleece the public. When people are afraid and there is money to be made, there is always someone ready to try and make an extra buck. Today’s New York Times has a story about a doctor in Westchester County outside New York City who performed Covid testing but charged insurance companies thousands of dollars for the testing. Without telling the patients, he used their samples to test for a wide variety of other viruses and billed the insurance companies for each of them. He even charged one patient’s insurer $480 for the phone call notifying her of her test results. The doctor is not only unrepentant, he is angry that some insurance companies have the nerve to refuse to pay. Be careful out there.
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November 9, 2020
Fantastic news on the Covid front. Pfizer has announced that its vaccine shows 90% effectiveness in preventing infections. A few weeks ago, Dr. Fauci said that we should be happy if we could get one that was 50-60% effective. By the end of the month, Pfizer expects to be in a position to request emergency approval from the FDA. It expects to have 1.5 million doses ready for distribution by the end of the year. Keep your fingers crossed.
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November 2, 2020
Medicare has announced its annual list of hospitals that will receive reduced payments because too many of their Medicare patients have been readmitted after being discharged. About half the hospitals in the country that are not exempt have readmitted too many patients and will receive reductions. Hospitals which are the only hospitals in an area are deemed critical and are exempted from the program. For example, here in Arizona, most of the hospitals on indian reservations are exempt. Here is a list of the hospitals of Arizona showing who is exempt and who has received a penalty. The larger the number in the box for a given year, the larger the penalty. Larger penalties result from more readmissions. The rate of readmission is widely considered to be a measure of the quality of care at a hospital.
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October 29, 2020
The FBI is warning hospitals and other health care providers that Russian speaking criminals are making ransomware attacks and that they need to take precautions. Six hospitals have been attacked so far this week. In a ransomware attack, the criminal hacks into the victim’s computer network and installs malware which encrypts all of the data on the system, making it inaccessible to the victim. The criminal then offers to restore the system to function in return for payment of a ransom. Most victims pay and the criminals usually keep their word to unlock the system. Very scary.
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October 27, 2020
More evidence that antibodies to Covid-19 weaken over time giving more support to the theory that infection with the virus does not provide lasting protection. A study from England that has not been peer reviewed showed rapid weakening of the Covid-19 antibodies over just three months. They dropped most quickly in the over-75 population and least quickly in the 18-24 age group. Additionally, those with the fewest symptoms had fewer antibodies and lost them soonest. The results of the study are a blow to those who were hoping for some sort of herd immunity to develop over time. The Covid-19 may be like the seasonal flu; you can get it year after year.
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October 26, 2020
If you are looking for an investment, consider stock in companies that make, sell or administer Botox. According to an article in this morning’s Wall Street Journal, the use of Botox is increasing, especially in Brazil, in response to the Coronavirus pandemic. It seems that the use of masks has concentrated attention on the eyes and the forehead so people want those areas to be wrinkle free. Similarly, the regular use of Zoom meetings has caused many people to think about how they look on camera and to take steps to improve their appearances. The pandemic won’t be over any time soon so there may be money to be made.
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October 22, 2020
In some good news on the Covid front, new polling finds more Americans wearing face masks when outside the home and not able to socially distance. While there are still substantial differences among our citizens, often based on political party, mask wearing across the board is up.
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October 20, 2020
There is a new procedure being performed on knees which have cartilage damage that typically leads to the need for a knee replacement. It is a two-step procedure in which the patient’s own knee cartilage cells are harvested during the first step and then replaced in the second step after being grown on a matrix. To allow the new cartilage to take hold and grow, the patient must remain bedridden for 6 weeks after the second procedure. Full activity requires a year of gradual recuperation. The procedure shows promise in the future for other joints, such as hips, shoulders and ankles.
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October 19, 2020
Here is a good piece on the myths associated with vitamins and supplements. Everyone wants to be healthy, to live a long life and to look like those models in the advertisements. The sellers of vitamins and supplements know this and tailor their ads accordingly. All is not as it seems.
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October 16, 2020
In 2017 and 2018 a nursing assistant at the VA hospital in Clarksburg, West Virginia, injected seven of her patients with fatal doses of insulin. Although she has admitted her guilt, she has not offered an explanation for her behavior. Needless to say, the families of the dead veterans have filed malpractice suits against the federal government for the care their loved ones received from the VA. Now come reports that 6 of the 7 cases arising from this tragedy have been settled. The final one will probably settle soon. Hospitals, and VA hospitals in particular, are dangerous enough without the staff actively trying to kill the patients.
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October 15, 2020
Our increasingly germ-free environment may be bad news for our immune systems. Those immune systems evolved over the millenia to protect us from a very germy environment. In our somewhat antiseptic world, our immune systems with nothing much to do have turned to attacking our own bodies. Autoimmune diseases are on the rise and their increased prevalence is blamed by some on diminished exposure to germs and other threats.
A small study in Finland brought forest soil and vegetation to preschool playgrounds. The children exposed to the forest soil had increased diversity of skin bacteria and gut microbes than children not exposed. These were perceived as beneficial changes. Those exposed also had more anti-inflammatory proteins and fewer inflammatory ones. Inflammation is a form of immune response which is believed to be harmful to the body. Bottom line, let you children play in the dirt.
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October 14, 2020
The Coronavirus pandemic has affected us in many different and sometimes surprising ways. One of the changes has been the increase in pet ownership. Whether this is surprising depends on how you think of pets. It seems people want a pet to keep them company in these difficult times when maybe we can’t go out of the house like we used to. The increase in pet ownership has increased the business for veterinarians, has increased sales of doggie and other pet products and has made stocks in companies related to pet care more expensive. Let’s hope that these pets continue to be loved and treated well after we are able to resume our normal lives.
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October 1, 2020
Contrary to recent assertions by someone who ought to know better, insulin is not as cheap as water. Insulin, which is needed by Type I diabetics in order to live, has been a huge moneymaker for the drug companies that manufacture it. Its price has increased by leaps and bounds since 2000. Between 2002 and 2013, the cost of insulin rose 197%. It’s meteoric price rise has continued since then. Despite many politicians claiming to be ready to do something about it or even claiming that they already have, prices remain unaffordable for many diabetics. Politicians, stop claiming to have done something about insulin prices and actually do it for a change.
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September 30, 2020
As early as April of 2020, doctors began noticing that some young people with Covid-19 were experiencing large vessel strokes. More recent analysis of the data found that in nearly half of the Covid patients under 50 who experienced a stroke, the stroke was the first sign of the disease. These patients were asymptomatic right up until the moment they experienced their stroke. They were diagnosed with Covid-19 after the stroke. Scary business.
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September 29, 2020
In 1975, in response to a “medical malpractice crisis,” California passed a cap on non-economic damages in malpractice cases. the cap was $250,000.00. While that may have been a sizeable amount in 1975, inflation has eroded the purchasing power of money by 80% but the cap was never changed. I blogged about the problem here. Now a citizen initiative will place the question of the cap on the 2022 general election ballot. The initiative proposes tying the cap to inflation, which would have the effect of raising the cap today to around $1.2 million. In addition, the initiative would allow juries to exceed the cap in cases of death and catastrophic injury and to award attorney’s fees to victims. Needless to say, opposition from the medical community will be fierce.
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September 23, 2020
Researchers are discovering that Vitamin D is even more important than they thought and they thought it was important before. Especially as we age, we can develop Vitamin D deficiencies. Low levels of Vitamin D have been linked to major age-related health problems, including osteoporosis (loss of bone mass), increased risk of death from cardiovascular disease, cancer, Type II diabetes and cognitive decline.
A great source of Vitamin D? The sun. For us here in Arizona, the strong sun is a free source of lots of Vitamin D. As always, don’t overdo a good thing.
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September 22, 2020
Uh-oh. Now that three of the drug companies testing three different potential vaccines for Coronavirus have released their testing protocols, other scientists can now evaluate those protocols. Here is an article from today’s New York Times, in which the author criticizes the testing as being too short and having the wrong endpoint. It is the author’s position that the testing will not tell us if the proposed vaccine will prevent the most serious cases of Coronavirus or only mild ones because it will end and a winner will be chosen before we know its effectiveness against serious cases. The author contends that preventing only mild cases is not worth either the effort or the risk of adverse consequences. Good article and worth the read.
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September 21, 2020
A dentist in Alaska, who made a tape of himself extracting a patient’s tooth while balancing on a hoverboard, has been sentenced to a lengthy prison term. His conviction was based, not only on the hoverboard incident, but on charges of embezzlement, fraud and unlawful dental acts. This guy was stupid enough to make a tape and send it to others, which led to his exposure. You have to wonder how many more are out there that are at least smart not to record their antics.
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September 19, 2020
Add AstraZeneca to the list of drug companies working on a Coronavirus vaccine that have released the protocols for their vaccine production and testing. AstraZeneca had been under fire for its secrecy, especially in light of the fact that two women injected with its vaccine prototype developed serious neurological illnesses.
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September 18, 2020
Pfizer has joined Moderna in releasing its protocols for testing the coronavirus vaccine. Two down and a couple of more to go.
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September 17, 2020
Moderna is one of the drug companies engaged in the race to produce a Coronavirus vaccine. Even people who are not Anti-Vaxxers have expressed concern about politicians pushing the vaccine makers to release a vaccine before it has been determined to be both safe and effective. Today, Moderna attempted to quell those concerns by releasing a 135 page protocol detailing the steps it has taken and will take before releasing a vaccine. Since these protocols are generally considered to be trade secrets, they are rarely released. Let’s see if any of Moderna’s competitors choose to follow suit.
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September 16, 2020
This story is a little far afield but relates to a common theme: doctors who will violate their ethical obligations and the law to make a few bucks. A German doctor is going on trial for setting up a large blood doping ring for cyclists and skiers. Blood doping involves transfusing red blood cells, which increase the oxygen-carrying capacity of the blood, into athletes to increase their stamina. He apparently was caught red-handed performing a blood transfusion immediately prior to a cross-country ski event. American doctors are not the only ones willing to act unethically for money.
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September 15, 2020
Greedy drug companies are in the news again. AstraZeneca, one of the largest of the big drug companies in the world, has raised prices on its best-selling drugs for the second time this year. It has raised prices by 6%, when the rate of inflation is only 1%. This action comes after it received hundreds of millions from the United States government to develop a vaccine for the coronavirus. Poor AstraZeneca. It made only $3.6 billion in operating profit in the first half of 2020. You can certainly understand why they need a price increase.
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September 11, 2020
As the population of the United States ages, there is increasing attention being paid to the process of ageing and its effects on older Americans. Here is a link to an article debunking a number of myths about ageing. Among the recommendations are the obvious: Be active, work on developing a positive mental attitude; eat healthy and get the sleep you need. Do as many of these things as you can and you give yourself the best chance to have a healthy and happy life.
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September 10, 2020
AstraZeneca is one of the drug companies testing a vaccine for Covid-19. It has paused its trials while it investigates a participant who has experienced a severe neurological problem. While it is unclear at this time exactly what the problem is, it seems to be a form of transverse myelitis, a rare inflammation of the spinal cord. It is also unclear whether the condition is related to the experimental vaccine or whether it is just a coincidence.
This is a good time to remember that vaccines, while immensely important and strongly protective, can, in rare instances, cause unexpected and unwanted adverse events. Should this happen to you, you should seek prompt medical treatment and then consider whether you have a legal remedy. The United States government has established a Court of Claims procedure for people injured by vaccines. Be sure to look into it, if you have had a bad reaction after receiving a vaccine.
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August 31, 2020
The FDA has granted emergency approval to an inexpensive Covid-19 test that can produce results in 15 minutes. The test, marketed by Abbot Laboratories, only costs $5.00 and can be administered by nurses and techs. Abbot hopes to sell millions of the tests and the federal government has already agreed to purchase 150 million of them. The wide availability of an accurate, rapid result test will be a big help in controlling the pandemic and returning the country to a more normal state of affairs.
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August 27, 2020
About those high drug prices . . . . Teva Pharmaceuticals, the largest generic drug maker in the world and one of the fifteen largest drug companies overall, has been charged by the United States Department of Justice with price fixing. It is alleged that Teva participated in conspiracies with other drug companies to fix prices on a number of drugs, including drugs for lowering cholesterol, managing arthritis and preventing blood clots. Teva is the latest company charged in these conspiracies. A number of other companies alleged to have participated in the conspiracies and to have fixed prices have already admitted their roles. You would think drug companies would be happy with the huge profits they make without having to resort to illegal conduct.
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August 25, 2020
In an embarrassing development, the head of the Food and Drug Administration, a cancer doctor before assuming control of the FDA, does not know the difference between absolute risk and relative risk. This is a mistake that would get you an “F” on a medical school examination.
A quick example of the difference. If you buy a second lottery ticket, you have doubled your chance of winning the lottery. Your relative risk of winning the lottery just went up 100%. On the other hand, your absolute risk of winning the lottery only changed from 1 in a million to 2 in a million. As you can see, there is a big difference and, when it comes to successful Covid treatments, the FDA chief needs to know the difference and be able to explain it to the public.
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August 24, 2020
Still too soon to tell what this means or how significant it might be but a Hong Kong man has been diagnosed with the Coronavirus a second time. On the first occasion, he had very mild symptoms. Four and a half months later, when he returned to Hong Kong from a vacation in Spain, he was tested again and found to be positive for a strain of the virus circulating in Europe. He had no symptoms from the second round with the virus. It may be that naturally acquired immunity is only short-lived. It may be that this is the rare case that proves the rule. It may be that any earlier exposure reduces the chance that a second infection will be serious. Just another data point in what will be a many year investigation of the Coronavirus.
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August 20, 2020
Although it is not always the case, research of out the University of Southern California suggests that the flu usually begins with a cough while the Coronavirus usually begins with a fever. Your mileage may differ.
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August 18, 2020
Bad news for those men who like to have a couple of drinks after work. Previous guidance was that the overall benefits of two drinks per day for men outweighed the health risks posed by alcohol. More research now shows that the benefits from alcohol on heart health are less than previously thought. Now researchers believe that the health risks of drinking outweigh the benefits, if more than one drink per day is consumed. They are taking all the fun out of life.
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August 7, 2020
The Department of Justice has rooted out another fraud on the taxpayers relating to Medicare. As is often the case, the scheme required the cooperation of doctors who were willing to accept bribes and kickbacks to order tests made by the company committing the fraud. The company was based out of San Diego and made a kind of DNA test. Their marketing Vice President admitted to paying bribes and kickbacks of at least $3.5 million. There may have been more. The doctors who accepted the bribes in return for violating their oaths were not identified. You better hope your medical care is not directed by someone willing to sacrifice you and your health in return for a bribe.
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July 22, 2020
A rare, life-threatening condition caused by Covid-19 has been found in children in Arizona. The condition is called Multi-System Inflammatory Syndrome. Symptoms include rashes, abdominal pain, fever, vomiting, diarrhea, fatigue and redness of the eyes. It seems to come on about three to six weeks after a Covid infection. Seek immediate medical help for your child, if you suspect he or she has this condition.
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July 22, 2020
During this pandemic with all the attention being paid to the Coronavirus, we should not forget our oral health. Certain foods and behaviors make tooth decay, gingivitis and bad breath more likely. Avoid sugary, highly processed foods. Increase your intake of leafy greens, fatty fish and citrus.
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July 20, 2020
Hoping not to get caught short on drugs necessary to treat coronavirus cases in the event of a new surge, many hospitals are stocking up on those drugs. This is having the unfortunate effect of creating a shortage in the very drugs that are most important. The coronavirus bad news just keeps on coming.
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July 11, 2020
As if we needed more bad news about the Covid pandemic, it is becoming apparent to researchers now that, in addition to its many other bad effects, the coronavirus can cause the onset of Type 1 diabetes in previously healthy individuals. Type 1 diabetes, an autoimmune disease, has been increasing at an alarming rate in developed countries, likely as a result of exposure to environmental factors. Finding a new cause for even more Type1 cases is very disheartening.
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July 2, 2020
The big drug maker, Novartis, is pleading guilty to fraud charges in a kickback scheme. As part of its plea deal, Novartis is admitting that it has been paying bribes and kickbacks to doctors for years to prescribe its medications. It’s spent millions. Of course, it takes two to tango. The kickbacks and bribes only work if there are unethical doctors ready and willing to accept them in return for prescribing the Novartis products. It doesn’t matter if the Novartis product is the best for the patient or not. And if you think they have caught all of the unethical doctors out there willing to sell out their patients, I am afraid you are very naïve.
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June 28, 2020
Gene therapy is coming, gene therapy is coming. Researchers at a stem cell conference reported encouraging results with gene therapy in monkeys to control high cholesterol and triglyceride levels. Our livers follow instructions from our genes about making cholesterol and triglycerides. Researchers have discovered that some people have a gene mutation, which keeps the liver from making elevated levels of these two substances. In the monkey experiment, the monkeys were given a shot which disables that gene directing creation of high cholesterol and high triglycerides. So far it is working but it will be years before they know it has no bad side effects and it may be ready for human trials.
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June 24, 2020
Transparency is coming. The federal government has ordered that hospitals disclose what they charge insurance companies for the treatment they provide to the company’s insureds. This has been a closely guarded secret by the hospitals. The amount they agree to accept from the health insurer is almost always only a small percentage of what they claim is their usual bill. Not surprisingly, hospitals don’t want you to know what they actually charge if you have insurance because you may use that information to negotiate a better deal for yourself, if you are a cash payer. Patients may also use that information to choose between hospitals providing like services. Patients may also see how unfair hospital bills are, if you do not have insurance.
The hospitals have been fighting this order in the courts. They recently suffered a significant setback when the court concluded that the order by the federal government was a reasonable one. I’m sure, however, that the battle is not over. The hospitals will continue to fight tooth and nail to keep you from learning this information, which is so important to an efficiently functioning healthcare system.
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June 19, 2020
Fake doctors are a thing. They are a thing in other countries and here in the United States as well. We in Arizona are not immune to them either. Back in March of this year, the Maricopa County Sheriff’s Office arrested a man who claimed to be a holistic medicine doctor and who was using this claim to defraud victims and to sexually assault women. According to the MCSO, he had been doing this since 2013. It amazes me that, with the resources available on line today, so many people can be fooled for so long a period of time. Don’t be a victim. Before going to see any medical provider, check his or her credentials with the appropriate state licensing board. Even if your provider is properly licensed, you may find important information which affects your care.
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June 16, 2020
As part of this week’s blog post, I wrote about the breach of trust by nursing homes in the Covid pandemic. Here is a similar story. A veteran living in a leased facility on the campus of a VA hospital in Massachusetts went missing on May 8. The staff reported him missing to the authorities. Yesterday, the veteran’s body was found in a stairwell outside the lease premises, but still on the VA grounds. He was wearing the same clothes he was wearing at the time of his disappearance. An investigation is underway but the operator of the leased premises and the VA are blaming each other and each claiming the other has exclusive control over the stairwell. In any event, it does not appear that anyone conducted much of a search of the premises when the veteran went missing. Someone, perhaps many someones, need to do a better job of caring for their patients.
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June 15, 2020
In a couple of weeks I will be doing an longer blog post on problems with our supply chain for medical equipment. In the meantime, the problem was acutely demonstrated by a story in the Wall Street Journal about Chinese medical supply manufacturers. These manufacturers are required by U.S. law to have an agent in the United States to serve as a point of contact between themselves and the Food & Drug Administration, in the event of problems or just to schedule one of the inspections the FDA does of foreign manufacturers. According to the Journal story, 1,300 of these manufacturers identified the same company as their agent and gave a Delaware address for the agent. There were a couple of problems. One is that there is no company by the name given. The second is that the address was a private home where no one knew anything about the alleged agent. Further investigation seemed to suggest that this was a misunderstanding by the Chinese manufacturers, that there was an agent and that they simply misidentified it en masse. Even if this explanation is true, it shows a shocking hole in the FDA’s ability to monitor these manufacturers. Given the number of defective medical products, including N-95 masks, that have been shipped out of China to protect our health care workers, we need all the oversight we can get. These manufacturers apparently don’t give a damn.
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June 9, 2020
I am going a little off topic today. I am writing about water safety. I have grandchildren, who come over to the house often. I also have a pool in my backyard, as do many Arizonans. If you have ever been around toddlers, you know how hard it is to keep track of them. You can turn your back for two seconds and they are out the door and into mischief. If you have a pool that is not properly secured, that can lead to tragedy. According to the Centers for Disease Control, after birth defects, drowning is the leading cause of death for children under four. Here is an article about things you can do to make it safer for the little ones who may visit your home. At my home, we have installed a removable fence with magnetic latches. It is manufactured by Katchakid and I have been very pleased. It is easy to set up and remove and has given me great peace of mind when my grandchildren visit. Whatever you choose to do, do something.
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June 3, 2020
I didn’t realize it but medical professionals say there is a right way and a wrong way to breathe. Breathing through the nose, when possible, is better than breathing through the mouth. Breathing through the nose allows the nostrils to filter out allergens and bacteria, to warm air that is too cold, and to humidify air that is too dry. There are some other tips that make this worth a read.
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June 1, 2020
Maybe you are not just scatterbrained. Maybe part of the problem is your diet. We have all heard that we are what we eat. A recent study shows that, following a meal high in saturated fats, it is often more difficult to concentrate. Researchers are not sure of the exact mechanism by which saturated fats affect concentration but they are confident of the relationship. More evidence that a Mediterranean diet is a good lifestyle change to adopt.
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May 18, 2020
Keep it moving, keep it moving. I don’t know where you are sitting out the coronavirus or if you are sitting it out at all. For those of us who have been spending more time at home, the temptation to snack or have a quarantini is hard to resist. This means excess pounds. The solution, besides more willpower, is to keep it moving and exercise. A good walk or run or some trips up and down the stairs can do wonders. As a matter of fact, exercise is good for us, pandemic or not, so keep it moving.
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May 13, 2020
For many years, PSA testing has been the primary way of determining if a man has or may have prostate cancer. Elevated levels of PSA (Prostate Specific Antigen) usually lead to an invasive biopsy. All in all this is a terrible way to diagnose prostate cancer.
PSA tests fail to identify many men with prostate cancer and, on the other hand, return positive results for many men who do not have prostate cancer at all. This means men who should be treated do not get treatment and men who should not be treated are, at a minimum, exposed to invasive biopsy procedures and unnecessary treatment.
The latest research shows that cancerous cells in the prostate produce molecules in the urine that can be detected. Here is a link to a recent article on the subject. The new testing is a step forward as it is accurate and non-invasive.
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May 7 2020
For those who are considering making their own face masks to address COVID-19 issues, here is an article suggesting some effective fabrics to use.
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May 5, 2020
There are news reports of a rapid, inexpensive but accurate test for COVID-19 using the Crispr gene-editing technology. Epidemiologists have stated that we will need rapid, accurate and inexpensive tests in order to fully reopen the country.
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April 29, 2020
Here is an article on making a homemade mask and a material combination that is highly effective at screening out even very small particles. A caveat, however, is that fit is critical. If the mask is not properly fitted to the face and has openings at the sides or top or bottom, at least 50% of the effectiveness is lost.
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April 28, 2020
Even during the Coronavirus pandemic, we can be grateful that the Justice Department is continuing to prosecute those who would defraud the taxpayers by ripping off the Medicare system. The latest is an orthopedic surgeon who agreed to reimburse the government $1.75M to resolve charges that he accepted bribes from a company that makes orthopedic medical devices. According to the government, he is the sixth physician to pay money to resolve allegations that he accepted bribes. Whenever there is money on the table, there will be doctors and others willing to forget their oaths and put their own interests ahead of those of their patients.
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April 27, 2020
We keep learning more and more about the things we already knew were bad for us. Chalk up another bad consequence of obesity. In addition to adverse effects on the cardiovascular system and Type II diabetes, it now appears that obesity makes you mentally slower and less able to mentally function. Here is a story on recent research into this subject.
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April 20, 2020
Heart disease is one of the most significant causes of death in the United States. We typically think of it as a disease of older Americans. Years of bad living have a way of catching up with us as we age. Younger people don’t need to worry about it as much. New research suggests that is not true.
A study which recently appeared in the Journal of the American College of Cardiology, the researchers report that they found coronary artery disease progressed rapidly in a very substantial population of otherwise healthy adults in their 40’s. The disease process was marked by the deposition of fatty plaques in the arteries. Once those are present, it is extremely difficult to remove them and, should they rupture, they can cause a heart attack. Word to the wise, take your cardiac health seriously, even in your younger years.
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April 10, 2020
This could be a game changer. Researchers in Great Britain and the United States have developed a blood test that can detect 50 different cancers with a 90% accuracy rate and can tell where in the body the cancer originated. Their results are reported in a paper in the Annals of Oncology. One of the greatest diagnostic problems in cancer treatment is that detection often comes late in the disease process and this means the cancer has gotten a big head start on the doctors trying to treat it. This blood test will allow doctors to discover cancer in its hiding places long before it would have been discoverable by the usual methods.
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April 2, 2020
Want some medical treatment but afraid to go to the doctor‘s office or the urgent care to get it? Maybe this is a good time to look into telemedicine instead. See the doctor online may be just the ticket. You are not alone.
According to the Wall Street Journal, telemedicine websites, which had been struggling to catch on, are being overwhelmed by patients. It will be interesting to see whether this newfound popularity continues after the coronavirus crisis passes and people are once again willing to visit the doctor in person.
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March 30, 2020
Taking a break from Covid news today. In a finding that should be important to all older people facing the prospect of potential dementia, researchers in Great Britain have discovered that most forms of frontotemporal dementia are accompanied by brain inflammation. This discovery, it is hoped, will aid them in developing new treatments to prevent the onset of dementia by addressing inflammation in the brain. Keep your fingers crossed.
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March 24, 2020
Not all doctors are putting the health of the public ahead of their own or that of their family in this time of crisis. In an apparent widespread practice, doctors are writing prescriptions for themselves and their families for drugs mentioned by the President as perhaps being effective against Coronavirus. These drugs were being used successfully by people with proven medical conditions, such as lupus. Because of hoarding by doctors, these people can no longer obtain the drugs they desperately need. Some state pharmacy boards have issued orders to stop this hoarding. They shouldn’t have to act to prevent doctors from behaving unethically.
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March 23, 2020
In these difficult times, here is some good news you may be able to use. Recent studies have found that daily meditation may slow the aging process in the brain. If there was ever a time when a little meditation would be particularly good for us, this is it. Commune with your inner self or your higher power. It can’t hurt and, beyond the usual benefits of meditation, may keep your brain young.
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March 19, 2020
I try not to get political on these pages but today I am reminded of the importance of the vote. In 2016, just a little over half of the people eligible to vote did so. Many of those who did not vote took the position that their vote is meaningless since all the candidates are the same. The Coronavirus crisis shows this is not true. It also shows that the consequence of the vote for President goes far beyond the actions of the President himself or herself. Far more significant are the actions of those who surround the President. In the case of the current administration, there was a hostility to science and to expertise and an elevation of the importance of ideology and personal loyalty to the President. As a result, many of our important health care institutions were hollowed out or were targeted for budget cuts. We are all paying the price for the consequences of the last Presidential election.
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March 16, 2020
1918 not only brought us the last year of the First World War, it brought us what has been called the “Spanish Flu,” an influenza outbreak caused by a novel virus for which human beings had no acquired immunity. Sound familiar? It should. It is very similar to the situation in which we find ourselves today with COVID-19. We can learn a lot from the experience of 1918. If nothing else, it should educate us about the risks inherent in a new virus. Take this virus seriously. It must be taken seriously by all of us because, if we don’t, we have the capacity to infect others through our carelessness.
It was less than two months ago that I wrote about the first case to arrive in the United States from China. At that time, it had killed only 6 people in China. That seems like a million years ago in terms of what has happened since. The world has changed and so have we. We still have a long way to go before this is even close to being over.
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March 10, 2020
Every day it seems as though there is another report on the benefits of exercise and activity on the human body. We evolved as hunters and gatherers, always on the move. The invention of the couch, the television and fast food came much later in our development. We are meant to be active and, when we are not, we pay the price. That said, it is never a good idea for a person who has been sedentary to suddenly take up high intensity interval training or any intense activity, for that matter. Sudden, high intensity activity in a sedentary person increases the risk of a heart attack. As one doctor put it, exercise is a medicine; too much or too little can be bad for you. The moral of the story for those of us who have not been active is to start out slowly, but to be sure to start out.
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March 9, 2020
Wash your hands often and don’t panic is the good advice being given by knowledgeable health care professionals. The same precautions we should be taking against getting the regular flu apply as well to the Novel Coronavirus (COVID-19). Exactly how deadly is this virus is a question that cannot be answered until scientists have more date with which to work, especially more Western data. Most of the cases so far have been in China and extensive, hard data from that country is not yet available. Additionally, this disease usually kills through pneumonia, a disease which affects the lungs. Many more men are heavy smokers in China than in the United States. Does that make a difference in the mortality risk? We don’t know but logic says it should. Practicing good personal hygiene is good for you and for those around you. We will make it through this together.
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March 4, 2020
The Feds are coming for bad nursing homes. If you are fortunate, you have not had a loved one in a nursing home. It is never a happy occasion to have to put a loved one in a nursing home, no matter how wonderful the home may be. Some are not so wonderful. They are understaffed, poorly maintained and uncaring about anything, other than the monthly charges. We see bedsore cases, cases of abused patients and cases of extreme neglect. Apparently, enough is enough. The Justice Department has announced the formation of a task force to address abuse, neglect and financial exploitation of the elderly in nursing homes. This is definitely a good thing.
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March 3, 2020
There are almost 200,000 children and adolescents in the United States living with Type 1 diabetes. One of them is my 9-year-old grandson. He is in his sixth year of living with the disease. As a result, I am very interested in Type 1 treatment news. Some good news just arrived. Researchers have succeeded in developing a method to force pluripotent stem cells, which can become any cell in the body, to become insulin producing beta cells. They have injected these cells into diabetic mice and have been able to return the ability of the mice maintain normal blood sugar levels for 9 months before the immune systems in the mice destroyed the new beta cells. The good news, of course, is that more stem/beta cells can be implanted to keep the process of normal insulin production going and going. Still a long way to go but very promising.
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March 2, 2020
There is an excellent story in the New York Times about the critical importance of medical examiners to public health and the many challenges they face due to underfunding and misunderstandings about their importance on the part of politicians and the public. A related problem is that there are just too few forensic pathologists to do all the autopsies that ought to be done. I strongly recommend you read the story and then see if your city or county is doing enough to protect the public by supporting this vital work.
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February 26, 2020
The coronavirus is coming. It is a question of when and not if. Here are some tips for protecting yourself. Among them, wash your hands frequently, keep your distance from people who are coughing or sneezing, avoid touching your eyes, nose or mouth, practice good respiratory hygiene and, seek medical care if you get sick.
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February 25, 2020
We all suffer from what are called “cognitive biases.” These are tricks the mind plays on us. They are the result of the mind trying to make sense of the world around it and making up shortcuts to accomplish its many tasks. Interestingly, we all suffer from the same cognitive biases, and that includes doctors. The cognitive biases of doctors affect the decisions they make when treating patients.
One common cognitive bias is confirmation bias. It refers to the tendency to look for and give greater weight to information that confirms something we already think. For doctors, it means they may look for evidence that confirms a tentative diagnosis they have already reached while at the same time ignoring evidence that points to a different diagnosis.
Another common cognitive bias is the anchoring effect. It involves the observer tending to give greater weight to the first piece of information he or she receives and less weight to subsequent information. If the first test results a doctor sees are normal, the doctor may give less weight to other test results which are abnormal.
Left digit bias explains why we see gasoline priced at $3.99 per gallon and believe it is substantially cheaper than gas at $4.00 per gallon. For doctors, seeing a lab result of 6.9 may be perceived as substantially less than a result of 7.1, even though the two are almost identical. That can have a major effect on decision making.
The medical profession is aware of the existence of these biases and is trying to address them. Some solutions are computer diagnosis programs with algorithms that push the doctor in the right diagnostic direction.
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February 20, 2020
I am not holding my breath but the Wall Street Journal reports that the big drug companies are losing the ability in Washington to block legislation aimed at reducing skyrocketing drug prices. This is primarily occurring because Republican lawmakers, who have been the primary defenders of the industry, are feeling threatened by the growing public insistence that something be done about high drug prices.
Don’t think the rise of drug prices is solely a Republican problem. The drug company lobbyists are equal opportunity influencers. They donate to Democrats as well as Rebublicans. Even when the Democrats controlled the White House and both houses of Congress ten years ago, the drug companies were able to block any meaningful legislation. Despite my skepticism, let us hope that this is indeed the dawn of a new day on Capitol hill.
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February 13, 2020
As usual, your mother was right. Washing your hands often is a good idea and one of the most effective means of preventing the spread of viral infections, such as the novel coronavirus sweeping China. While a short wash with soap is better than no wash at all, a longer wash of about 20 seconds is the most effective and efficient. Be sure to get the back sides of the hands and between the fingers too. Hand sanitizers are helpful but no substitute for a thorough wash.
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February 11, 2020
“Eat more fish.” That is the conclusion to be drawn from a large study seeking to compare the heart risks associated with eating processed meats, unprocessed red meats, chicken and fish. All but fish increased the risk of cardiovascular disease, with processed meats leading the way. The study has some limitations but is important, nonetheless.
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February 10, 2020
New imaging technology involving low dose x-rays permits full body x-rays which may eliminate the need for some autopsies or eliminate the need for certain steps in an autopsy. This can be important for those religions that frown on the physical intrusion to the deceased that happens during a routine autopsy. Here is a link to a story about this technology.
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February 6, 2020
File this under “What took you so long?” A New Jersey oral surgeon was temporarily suspended in 2016 after multiple inspections of his office by the Department of Health found unsanitary practices. He is in the news because he has finally agreed to a five year suspension and payment of $300,000 in fines. During the time the health department was finding, documenting and warning about unsanitary practices, the doctor was allowed to continue to perform oral surgery. During that four year time period, 15 of his patients developed heart infections, many of which led to heart valve surgeries, and one of which led to death. None of the patients who developed bacterial endocarditis had a history of heart issues before becoming patients of the surgeon. One of the patients who needed heart valve replacement was only 26. Undoubtedly, this malpractice is the subject of multiple lawsuits but the question still remains, “What took so long to suspend this guy?” How many times do you have to find him in violation of safety rules before you shut him down? I respectfully submit that four years is too long.
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February 3, 2020
More bad news from China. It’s not just the coronavirus. As with so many products these days, most surgical gowns are manufactured in China. A large surgical gown manufacturer in China has been discovered using factories that have not been registered with the Food and Drug Administration. The factory has not been meeting cleanliness standards and at least some of the surgical gowns have been contaminated and are not sterile. To make matters worse, the gowns are often packed along with other sterile items used in the operating room. Millions of the surgical gowns have been recalled as have the packages containing the other surgical equipment. This has caused substantial hardship at some hospitals. Some surgeries have had to be cancelled or rescheduled because of the recall. Here is a link to a CBS news story on the recall.
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January 31, 2020
I am not a coffee drinker but my wife sure is. On top of that, my son owns one of the best coffee shops in Phoenix, Copper Star Coffee on 7th Avenue. Caffeine is the most widely used psychoactive substance in the world. Many people use it to fire up their brain and to get some extra energy. According to a recent study, acute exercise can be just as good for the brain as it is for the body. Acute exercise is as effective as caffeine in stimulating the brain, improving memory, and making you feel energetic. Why not both?
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January 29, 2020
Researchers have discovered the secret to a longer, healthier life. Guess what? It isn’t a secret at all. Avoid these five behaviors and you significantly increase your chances for an extra seven to ten years of disease-free life. The bad five to avoid: Smoking; Drinking too much alcohol; Not exercising; Being overweight; and Eating an unhealthy diet. Now you know.
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January 21, 2020
The first case of the new Chinese coronavirus has reached our shores. A gentleman who just returned to the United States from Wuhan, China, the epicenter of the disease outbreak, tested positive for the virus and is in hospital isolation in the state of Washington. The disease has killed six and sickened hundreds in China so far.
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January 17, 2020
Disappointing news from a large test of whether active measures can keep the sickest patients from relapsing and returning to the hospital. Five percent of the patients are responsible for about half of all health care spending. One theory has been that if we could spend some money following up with these patients, making sure they are taking their meds, eating right, and getting appropriate preventive care, maybe we can keep them healthy enough to stay out of the hospital. This test found that it was very difficult to keep these people out of the hospital and that all the interventions did not seem to make a difference. Time to go back to the drawing board.
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January 16, 2020
Well there is good news and bad news on the economic and health fronts today. The good news on the economic front is that the economy is nearing full employment. People who want to work can find jobs and wages are rising as employers are forced to compete for employees. The bad news on the health front is that, for every 1% decrease in the jobless rate, there is a 16% increase in the number of doctor visits because of the flu. The speculation is that more crowded workplaces facilitate the spread of the flu from worker to worker. Best advice is to get your flu shot, wash your hands often and stay home, if you are sick.
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January 15, 2020
In an unexpected finding, deaths due to cardiovascular disease are rising throughout the United States among middle aged people, aged 450 to 64. By contrast, deaths due to cardiovascular disease are less among older Americans. This was a finding made by the Wall Street Journal when it examined mortality statistics. The future does not look good either as many elementary school children are obese and have high or borderline high cholesterol already.
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January 10, 2020
In what could turn out to be a very significant development in the delivery of affordable health care in the United States, California is looking into contracting with generic drug makers to produce drugs California could then sell/distribute to its citizens, many of whom are on Medicaid. The investigation is said to be in its very earliest stage. All I can say is that it is about time someone did something about runaway drug prices.
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January 6, 2020
A pair of San Diego ophthalmologists are paying the federal government nearly a million dollars to resolve claims of Medicare fraud. A doctor who used to work at the practice filed a whistleblower complaint and will get a sizable check as a result of the settlement. The doctors submitted bills to Medicare for treatment they claimed was performed by them but was actually performed by another doctor who was not qualified to treat Medicare patients. According to the federal government, this constitutes Medicare billing fraud. Here is a link to some local news coverage of the settlement.
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January 3, 2020
I read something today that really surprised me and may surprise you. The most significant modifiable risk for developing dementia is hearing loss. Hearing loss exceeds smoking, social isolation, high blood pressure and lack of exercise as modifiable risks for dementia. And it doesn’t even have to be a big loss in hearing. Even a small loss in hearing can increase the risk of dementia. Here is a New York Times article on the subject. One of the author’s recommendations is to use noise cancelling earbuds so that you don’t have to jack the volume up in order to be able to hear your music. I am on my way to get a set of the new Apple AirPods Pro earbuds with noise cancelling. I like my music and my brain.
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January 2, 2020
While artificial intelligence (AI) is not an unalloyed blessing, it does have the potential to improve our lives in many ways. One of the ways is in reading x-rays. Already, trained computers can detect lung cancers, eye disease and kidney injury better than most radiologists. This is a good way to back up radiologists and improve the quality of care. A recent article in the Wall Street Journal describes the successful use of Google Health’s AI to detect breast cancer better than many doctors. It also was reported to reduce the number of false positives. A false positive occurs when a study is read as showing cancer or likely cancer. It is a problem because it means more testing and perhaps a biopsy to rule the breast cancer in or out. The new breast cancer algorithm is not yet ready for prime time but demonstrates the advances being made in this important area.
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