Healthcare Outsider

Has anyone ever given you some advice they themselves would never take? Did your parents ever tell you to “grow up” despite the fact the they often acted like children? Has your psychiatrist ever exhibited the tics and neuroses of a truly crazy person? If you answered yes to any of these questions, you might be able to grasp the stunning irony of the recent CDC morbidity and mortality data which suggests that medical professionals were one of the least-vaccinated  groups in america for H1N1, as well as seasonal flu.

The medical community’s apparent reluctance to get the shot bolsters the resolve of the already-paranoid tea partyers, conspiracy theorists, and pregnant single mothers who believe the inoculation is part of a government plot to take our children and turn our minds to Jell-o. When you think about it, drug-induced complacency might explain how the administration managed to get the health care bill through without starting a civil war.

-Michael B. Sauter

The numbers are in, and it looks like there’s going to be even more coal in the stockings of physicians come Christmas. According to modernhealthcare.com, the Federation of State Medical Boards reports disciplinary action against doctors is up 6% from last year to over 5,700 total cases nationwide. This prompts the question: why this sudden trend? read more »

The New York Times reports that a group of disgruntled scientists in the FDA are planning on testifying that their superiors ignored their reports on the dangers of using CT scans – a common form of diagnostic radiation – in place of colonoscopies. The members claim that they had determined there to be a significant carcinogenic risk of the scan, and believe that roughly 14,000 people die each year from tumors caused by the controversial treatment. The FDA, they assert, chose to ignore and bury their reports as they sought to approve the G.E. manufactured scanner for usage in diagnostic imaging of the colon.

After reading this, anyone who thinks the FDA’s first priority will always be our health may need to get their head examined… with a dangerously radioactive scanner.

-Michael B. Sauter

Medicaid, the national medical insurance program designed to provide coverage for the least advantaged Americans, has been slowly losing funding since being created as part of the 1965 social security act. Now, as medical costs continue to skyrocket, small practices are losing money because their states have set standard payment rates lower than the costs of the treatments. Rather than lose money and their practices, small town physicians are opting out of treating Medicaid recipients. This trend is sending the nation’s poor and sick on costly hunts for doctors who will agree to treat them. [CNN Money]

In light of this, it’s tough to tell why people might be clamoring for health care reform…

-Michael B. Sauter

American researchers have now figured out what to do with that human genome they worked so long to decode. Using a process called “whole-genome screening,” the American scientists were able to diagnose a patient with a rare disease by comparing their DNA structure with a normal one. The disease, by the way, is probably so rare because it has such a ridiculous name: Charcot-Marie-Tooth syndrome.

This procedure, which should assess diseases and genetic dispositions with near-perfect accuracy, might be the harbinger of a new era in diagnostic medicine. There’s only one problem: the estimated $50,000-per-sequencing price tag. If whole-genome screening becomes the modus operandi, we could be looking at a nation full of poor, healthy people. Ok, maybe they won’t all be healthy, but at least they’ll know what’s wrong with them. [MedPageToday]

-Michael B. Sauter

A study at three major hospitals has revealed that doctors are probably not euthanizing children dying of cancer, thank goodness. The report, which compared parent interviews with statistics of 141 cases of terminal cancer in children, showed that doctors were most likely administering safe doses of morphine to children, despite some requests by their parents to administer lethal amounts to end their suffering. Any subsequent deaths, the report concludes, were likely coincidental, and not due to overdose. We can all breathe easily, knowing our national priority is still that of preserving life at all costs, even if that life is actually just three days of unbearable pain, ending in an undignified and even more horrible death. [NYT]

-Michael B. Sauter

A few days ago, the results of a study entitled “Aspirin Intake and Survival”  was published in the Journal of Clinical Oncology. Within 24 hours, the findings of the report – which pointed to the household painkiller as a possible miracle drug in breast cancer treatment – were being heralded in all the major media as one of the most significant medical breakthroughs in months. The 30-year observational report, conducted by over 4,000 nurses from around the country, determined that  female patients who regularly took Aspirin in conjunction with their treatment had a 50% better survival rate than those who did not. To be sure, if these numbers are accurate, this is a major breakthrough in the way we treat the deadliest form of malignancy among females, and the second-deadliest overall (after lung cancer.)

Before we all breathe a sigh of relief and afflicted women and those who believe they may be at risk head to Costco to buy the painkiller in bulk, we should be very sure we understand what this study really means, and how seriously we want to take the results. Most importantly, we should understand what doctors are saying about the study.

In an article released in the women’s health blog womensvoicesforchange.org, Dr. Bonnie Reichman, an oncologist at the Cornell Medical Center, considered the merits of the study and its implications. She explained that the general consensus among oncologists at the moment is one of tentative optimism. “This is an observational study,” she explained, “relying on self-reporting of aspirin use four years after breast cancer diagnosis – the results are suggestive, mind you, not conclusive, of the possible benefit of taking aspirin in preventing distant recurrences … and deaths due to breast cancer.”  She added that Doctors believe that the anti-inflammatory effects of the medicine the likely cause of Aspirin’s apparent mollification of the cancer.

Despite a certain level of optimism, Reichman, like many other physicians, stress that we approach these results with caution. She explained that while it is an over-the-counter medication “Aspirin is not a benign drug and can cause bleeding, especially from the stomach.” While the data remains as tenuous as it currently is, we shouldn’t think of the drug as a foregone conclusion that every afflicted patient should begin taking right away, but it certainly should be considered – with the consultation of the patient’s oncologist – as part of their comprehensive treatment plan. “At this time” she concluded, “routine use of Aspirin is not indicated—and won’t be, until these interesting results are confirmed in a properly conducted prospective trial.

A link to Reichman’s Article can be found here: womensvoicesforchange.org

-Michael B. Sauter

The FDA warned yesterday that Advair, an commonly prescribed asthma medication from pharmaceutical company GlaxoSmithKline Plc. , should not be used in the long-term because, Bloomberg reports, they contain long-acting beta agonists, which “have been linked to increased risk of worsening asthma symptoms, hospitalizations and deaths.” As you might expect, this has had some negative effects on the sales of the drug, as most asthma patients want their conditions to “improve” and not “worsen,” but makers of the drug insist that it is a perfectly viable solution for short-term treatment of the respiratory disease.

-Michael B. Sauter

Here’s a quiz: when the reported cases of a disease goes up, should researchers and policymakers interpret that to mean: A, some environmental factor has led to an actual increase in cases, B, the total number of cases hasn’t changed but doctors are better able to identify the condition, C, paranoia and hyper-awareness has led to over-diagnosis, or D, some or all of the above? The answer? It is often impossible to tell, but HCO suspects there is rarely one singular reason, that D will be right most of the time.

This question is something we should think about when considering a recent study released by the American Medical Association’s journal,  which showed that the number of chronic debilitating conditions, such as obesity, ADHD, and a variety of neurological disorders went up 14% between 1994 and 2006. What could possibly be the cause of such a massive turn for the worse in children’s health?

One of the members of the research team that released the study, Dr. Neal Halfon of the UCLA Center for Healthier Children, Families and Communities, suggested that indeed, there are several reasons that we’ve seen the rate of some of these disorders shoot up 10 to 20 percent in the past few decades.  He explained that the parameters for defining these diseases have changed, and this may have some impact on the increase, but also explained that worsening environmental factors have had a big influence in this phenomenon as well. While you can’t exactly misdiagnose obesity, in the case of Attention Deficit Disorder, a relatively modern disease, we are seeing both better awareness of what to look for and, we suspect, a great deal of over-diagnosis as a result of insistent parents inflated expectations.

This study also showed that despite the increase in instances, the children whose chronic condition persisted was merely 7.4%. Why should we be concerned with disorders that our children can usually shake off by the time they get into the real world? The answer, of course, is that these conditions have all kinds of lasting consequences and complications down the road (obesity in particular,) even if the original problem is no longer there. This means we’re going to be dealing with this surge of childhood diseases in the future in the form of increased insurance bills and larger federal healthcare deficits, something we’re kind of having a problem with already. [LA Times]

-Michael B. Sauter

The Governor of Georgia, Sonny Perdue, has proposed a hospital “bed” tax in an attempt to deal with the State’s escalating medicaid crisis. While state legislators acknowledge that there is indeed a crisis, an impending $608 million deficit in the budget from insurance costs for the poorest Americans, they take issue with the Governor’s solution.

The “bed” tax would require hospitals to hand over 1.6 percent of the revenue they accumulate from inpatients to the state. Opponents of the measure argue that this tax will only drive hospital costs up, increasing the medicare and medicaid burden on the state. The dominant counter-proposal to the bill is a cigarette tax. This bill, they argue, wouldn’t increase medical costs, but would cause people to improve their health-related habits, decreasing the overall health insurance burden on the state.

Of course, the third major option on the table is an overall cut in Medicaid eligibility and percent coverage, but this could also end up doing serious harm to hospitals, patients, and the insurance system, as many hospitals depend on Medicaid-derived insurance to stay afloat. Watch the outcome of this crisis closely, the outcome could determine what direction other states – or even the federal government – chooses to go in as the bulk of the baby boom is poised to retire and drive Medicare spending through the ceiling.

-Michael B. Sauter