Archive for the ‘Healthcare’ Category
It’s a valid question, I think. His column in the NY Times begins:
It is becoming easier to get marijuana, legally. In the last 20 years or so, 23 states, as well as the District of Columbia, have passed laws that make it legal to use marijuana for medical treatments. So have some countries, like Austria, Canada, Finland, Germany, Israel and Spain.
Advocates believe that this has allowed many with intractable medical problems to receive a safe and effective therapy. Opponents argue that these benefits are overblown, and that advocates ignore the harms of marijuana. Mostly, opponents say that the real objective of medical marijuana is to make it easier for people to obtain it for recreational purposes.
Both sides have a point. Research exists, however, that can help clarify what we do and don’t know about medical marijuana.
A recent systematic review published in The Journal of the American Medical Association looked at all randomized controlled trials of cannabis or cannabinoids to treat medical conditions. They found 79 trials involving more than 6,400 participants. A lot of the trials did show some improvements in symptoms, but most of those did not achieve statistical significance. Some did, however.
Medical marijuana was associated with some pretty impressive improvements in complete resolution of nausea and vomiting due tochemotherapy (47 percent of those using it versus 20 percent of controls). It also increased the number of people who had resolution of pain (37 percent up from 31 percent). It was shown to reduce pain ratings by about half a point on a 10-point scale, and to reduce spasticity in multiple sclerosis or paraplegia in a similar manner.
Those aren’t insignificant results and they are supported by other studies that have confirmed that marijuana and cannabinoids can help withrefractory pain. But most researchers stress that they should be consideredonly when other therapies have failed.
There’s a little bit of evidence that marijuana might help with anxiety disorders and with sleep. . .
And so on. And he rightly points out the malign effects of a common prescription drug replaced by marijuana: opioid painkillers, which as he notes have plenty of problems (overdoses, addictions) of their own. Using marijuana in lieu of the painkillers could avoid harm—and, according to evidence, it does indeed reduce harm in that are. In other words, we must consider all the effects of alternative treatments (such as opioid painkillers), rather than considering only the good effects: opioid painkillers come with a high overall cost—including the literal cost: a patient using opioid painkillers cannot simply grow his own rather than buying prescriptions.
Moreover, alcohol is a very dangerous drug (overdoses, addiction, injuries up to and including death to self and others due to being actively inebriated: all well documented), and quite often the use of marijuana displaces the use of alcohol, another instance of harm avoidance and, given the medical dangers of alcohol (cirrhosis of the liver, for one), certainly should be considered in the context of marijuana’s overall contribution to medicine and healthcare. And Carroll also addresses that issue in another column.
It’s interesting that the GOP leaders’ bad-mouthing of the Affordable Care Act has indeed worked to prevent many Republicans from signing up. Seth Masket looks at the phenomenon in Pacific Standard:
One of the big public health stories over the past few years has been the sharp decline in the number of uninsured Americans since the implementation of the Affordable Care Act. This decline has not been even across the United States population, though. We know that poorer people, African Americans, Latinos, and other demographic subgroups have benefited more rapidly from this act than others. But it also turns out that there’s a partisan component: Democrats are benefiting more than Republicans.
As Michael Tesler reported at the Monkey Cage last week, the percent of uninsured who are Democrats has essentially been cut in half over the past two years, while the percent of uninsured who are Republicans has barely budged. One might just dismiss this as a feature of demographics: Democrats tend to be poorer than Republicans and to live in states that have more aggressively adopted health exchanges. Yes, that’s true, but Tesler actually controls for all sorts of demographic factors, including race, income, and state of residence, and still finds a large partisan effect. What’s going on here?
One possible explanation is that Republicans are constitutionally less inclined to seek out a public service until they desperately need it. That would be consistent with some of the anecdotes we’ve seen about people who were opposed to Obamacare on ideological grounds but enrolled in it when a medical crisis hit their family. And conversely, Democrats may be constitutionally more comfortable with signing up for a government service. These differences, that is, may simply reflect the general attitudes of liberals and conservatives toward actions by the government and toward collective action in general.
Even if the government is not involved, after all, insurance is all about pooled money and calculated risk. When you buy health insurance as a healthy person (and if you expect to be healthy much of your life), you accept that a good deal of the money you put in will go to benefit other people. Republicans might simply be more likely to see this as a scam, while Democrats view it as a social responsibility.
But another related explanation for the partisan differences in health insurance enrollments just has to be . . .
Full disclosure: I’ve run into the misuse of Hipaa with regard to family members myself. Paula Span discusses how health professionals often have incorrect ideas about the law:
How do people use, misuse or abuse Hipaa (Health Insurance Portability and Accountability Act), the federal regulations protecting patients’ confidential health information? Let us count the ways:
■ Last month, in a continuing care retirement community in Ithaca, N.Y., Helen Wyvill, 72, noticed that a friend hadn’t shown up for their regular swim. She wasn’t in her apartment, either.
Had she gone to a hospital? Could friends visit or call? Was anyone taking care of the dog?
Questions to the staff brought a familiar nonresponse: Nobody could provide any information because of Hipaa.
“The administration says they have to abide by the law, blah, blah,” Ms. Wyvill said. “They won’t even tell you if somebody has died.”
■ Years ago, Patricia Gross, then 56, and a close friend had taken refuge in a cafe at Brigham and Women’s Hospital in Boston, where Ms. Gross’s husband was dying of cancer. She was lamenting his inadequately treated pain and her own distress when a woman seated at a nearby table walked over.
“She told me how very improper it was to be discussing the details of a patient’s treatment in public and that it was a Hipaa violation,” Ms. Gross recalled.
■ In 2012, Ericka Gray repeatedly phoned the emergency room at York Hospital in York, Pa., where her 85-year-old mother had gone after days of back pain, to alert the staff to her medical history. “They refused to take the information, citing Hipaa,” said Ms. Gray, who was in Chicago on a business trip.
“I’m not trying to get any information. I’m trying to give you information,” Ms. Gray told them, adding that because her mother’s memory was impaired, she couldn’t supply the crucial facts, like medication allergies.
By the time Ms. Gray found a nurse willing to listen, hours later, her mother had already been prescribed a drug she was allergic to. Fortunately, the staff hadn’t administered it yet.
Each scenario, attorneys say, involves a misinterpretation of the privacy rules created under the Health Insurance Portability and Accountability Act. “It’s become an all-purpose excuse for things people don’t want to talk about,” said Carol Levine, director of the United Hospital Fund’s Families and Health Care Project, which has published a Hipaa guide for family caregivers.
Intended to keep personal health information private, the law does not prohibit health care providers from sharing information with family, friends or caregivers unless the patient specifically objects. Even if she does object, is not present, or is incapacitated, providers may use “professional judgment” to disclose pertinent information to a relative or friend if it’s “in the best interests of the individual.”
Hipaa applies only to health care providers, health insurers, clearinghouses that manage and store health data, and their business associates. Yet when I last wrote about this topic, a California reader commented that she’d heard a minister explain that the names of ailing parishioners could no longer appear in the church bulletin because of Hipaa.
Wrong. Neither a church nor a distraught spouse is a “covered entity” under the law.
Last month, Representative Doris Matsui, Democrat of California and co-chairwoman of the Democratic Caucus Seniors Task Force, who has heard similar complaints from constituents, introduced legislation to clarify who can divulge what and under what circumstances. The proposed bill would require the Department of Health and Human Services, which last year issued new Hipaa “guidance,” to make that statement part of its regulations and to create model training programs for providers and administrators, patients and families.
“A lot of times it’s just misunderstanding what is and isn’t allowed under Hipaa,” Representative Matsui said in an interview.
So, what is and isn’t? . . .
I don’t understand why the acronym is treated as a proper noun. My inclination would be to spell it in all caps: HIPAA, just as I would use “NATO” rather than “Nato.”
Marshall Allen and Olga Pierce report in ProPublica:
IN FEBRUARY 2012, LaVerne Stiles went to Citrus Memorial Hospital near her home in central Florida for what should have been a routine surgery.
The bubbly retired secretary had been in a minor car accident weeks earlier. She didn’t worry much about her sore neck until a scan detected a broken bone.
The operation she needed, a spinal fusion, is done tens of thousands of times a year without incident. Stiles, 71, had a choice of three specially trained surgeons at Citrus Memorial, which was rated among the top 100 nationally for spinal procedures.
She had no way of knowing how much was riding on her decision. The doctor she chose, Constantine Toumbis, had one of the highest rates of complications in the country for spinal fusions. The other two doctors had rates among the lowest for postoperative problems like infections and internal bleeding.
It’s conventional wisdom that there are “good” and “bad” hospitals — and that selecting a good one can protect patients from the kinds of medical errors that injure or kill hundreds of thousands of Americans each year.
But a ProPublica analysis of Medicare data found that, when it comes to elective operations, it is much more important to pick the right surgeon.
Today, we are making public the complication rates of nearly 17,000 surgeons nationwide. Patients will be able to weigh surgeons’ past performance as they make what can be a life-and-death decision. Doctors themselves can see where they stand relative to their peers.
The numbers show that the stark differences that Stiles confronted at Citrus Memorial are commonplace across America. Yet many hospitals don’t track the complication rates of individual surgeons and use that data to force improvements. And neither does the government.
A small share of doctors, 11 percent, accounted for about 25 percent of the complications. Hundreds of surgeons across the country had rates double and triple the national average. Every day, surgeons with the highest complication rates in our analysis are performing operations in hospitals nationwide.
Subpar performers work even at academic medical centers considered among the nation’s best.
A surgeon with one of the nation’s highest complication rates for prostate removals in our analysis operates at Baltimore’s Johns Hopkins Hospital, a national powerhouse known for its research on patient safety. He alone had more complications than all 10 of his colleagues combined — though they performed nine times as many of the same procedures.
By contrast, some of the nation’s best results for knee replacements were turned in by a surgeon at a small-town clinic in Alabama who insists on personally handling even the most menial aspects of each patient’s surgery and follow-up care.
ProPublica compared the performance of surgeons by examining five years of Medicare records for eight common elective procedures, including knee and hip replacements, spinal fusions and prostate removals.
To be fair to surgeons, ProPublica’s analysis accounted for factors such as patients’ health and age. We focused only on elective cases because they typically involve healthier patients with the best odds of a smooth recovery.
As would be expected, . . .
At the link, the app is available.
Edwin Evans-Thirlwell reports at Motherboard:
Big Pharma is a management simulation game that, to quote its UK-based creator Tim Wicksteed, explores “the strange ethical dilemmas that occur when you bring together the goal of curing the sick with the burden of running a profitable business.”
Unlike many an artwork with a social or political message, however, it isn’t an exercise in pointing fingers. Rather, Big Pharma shows how dangerously easy and routine it can become to disregard the human fallout of a decision while operating in an abstract world of market trends and logistical planning.
The game’s world isn’t just abstract—it’s downright cosy. Now available in beta to pre-ordering players, with a Steam release to follow, Big Pharma recalls the cartoon look and handling of the Bullfrog-developed classic Theme Hospital. Most of it takes place on your production floor, a cheery expanse of checkerboard floating in a clinical grey void, where you buy and click together chunky, pleasingly animated machines that turn raw materials into products such as pills and creams.
Each ingredient must be discovered by hiring explorers to scour the unseen world beyond your factory, then imported for a fee. All of them have a number of possible effects, good and bad. To unlock or cancel out these traits, you need to feed the ingredient through various devices that alter its concentration, or combine it with another substance, before ferrying the results to the export hopper. In theory, of course, you’ll want to ship the most effective cures you can while ironing out negative symptoms such as constipation. But in practice, this may not make sense economically.
Each component in a production line takes a small chunk out of your earnings each and every time it’s used, so the more elaborate the purification and enhancement process you set in motion, the smaller your net profit. A cheap ‘n’ dodgy migraine remedy that causes hypertension and diarrhea may prove more lucrative, overall, than an expensive miracle cure that obliges you to fill up your real estate with ionisers and condensors.
More sinisterly yet, Big Pharma also generates an evolving worldwide market simulation that takes into account the global distribution of diseases versus the distribution of income. Thus, in addition to letting the player cut corners with each drug, it allows you to callously ignore regions where the need for treatment is greatest but wallets are light.
“A cure for hair loss is a relatively small market but is highly valuable to the rich Westerners who demand it,” Wicksteed told me by email. “Whereas an antimalarial drug is in very high demand but can’t sustain such a high price, because most of the demand is coming from people living in poorer countries.”
There’s the projected infection rate of each disease to consider, too. “You can deliberately hold off producing your tuberculosis remedy until it infects half of Africa, in order to maximise your profits.”
Wicksteed became interested in such ethical breaches after reading Dr Ben Goldacre’s acclaimed 2012 book Bad Pharma, which examines how companies such as GlaxoSmithKline have distorted or buried data about the usefulness and drawbacks of their products. On balance, he feels that such failings are evidence of “systematic” problems rather than confined to a particular set of corporations.
“People are incentivised to make decisions for the good of the company or themselves to the detriment of patients,” Wicksteed commented. “This is very human. It’s something we’ve all encountered at work under the pressure to hit a deadline or get a certain result. The problem with this in the pharmaceutical industry is that it can lead to human suffering, or worse, death. It’s because of this that I try to avoid overtly demonising the industry in the game, and prefer to simply place the player in a position of power and ask ‘what would you do?’”
Not very encouragingly, Wicksteed has found that Big Pharma players “are very profit driven, and don’t give a second’s thought to sacrificing quality to make a few extra dollars per sale.” This may, however, reflect a lack of in-game accountability systems to counter the siren wail of your company’s bottom line—compromised or feeble remedies sell for less, but there’s no blowblack from injured members of the public, and no threat of a legal challenge. . .
Continue reading. Fascinating article, which supports my own view that for-profit hospitals should be illegal.
Here’s a promo video of the game. Turn off sound to avoid irritating and irrelevant music:
Businesses cannot be trusted, it repeatedly turns out. Charles Ornstein reports in ProPublica:
A nurse practitioner in Connecticut pleaded guilty in June to taking $83,000 in kickbacks from a drug company in exchange for prescribing its high-priced drug to treat cancer pain. In some cases, she delivered promotional talks attended only by herself and a company sales representative.
But when the federal government released data Tuesday on payments by drug and device companies to doctors and teaching hospitals, the payments to nurse practitioner Heather Alfonso, 42, were nowhere to be found.
That’s because the federal Physician Payment Sunshine Act doesn’t require companies to publicly report payments to nurse practitioners or physician assistants, even though they are allowed to write prescriptions in most states.
Nurse practitioners and physician assistants are playing an ever-larger role in the health care system. While registered and licensed practice nurses are not authorized to write prescriptions, those with additional training and advanced degrees often can.
A ProPublica analysis of prescribing patterns in Medicare’s prescription drug program, known as Part D, shows that these two groups of providers wrote about 10 percent of the nearly 1.4 billion prescriptions in the program in 2013. They wrote 15 percent of all prescriptions nationwide (not only Medicare) in the first five months of the year, according to IMS Health, a health information company.
For some drugs, including narcotic controlled substances, nurse practitioners and physician assistants are among the top prescribers. . .
Again we see the paradox of GOP condemnation of Obamacare: they love what it does, but they hate the name. (And, of course, they have NEVER proposed any alternative: it’s not their way to develop solutions; their only interest is in destruction.)
Lee Fang reports in The Intercept:
The conventional wisdom on Senator Bernie Sanders of Vermont is that he’s a charming if impractical dreamer, a pie-in-the-sky socialist who’s good at inspiring young people and aging hippies, but hopeless at the knife fighting that real-life politics requires.
Despite the inherent limitations of a self-described democratic socialist who eschews the norms of Beltway fundraising, the Democratic presidential candidate from Vermont has won legislative victory after victory on an issue that has been dear to him since his days as Burlington’s mayor.
That issue is the simultaneously benign and revolutionary expansion of federally qualified community health clinics.
Over the years, Sanders has tucked away funding for health centers in appropriation bills signed by George W. Bush, into Barack Obama’s stimulus program, and through the earmarking process. But his biggest achievement came in 2010 through the Affordable Care Act. In a series of high-stakes legislative maneuvers, Sanders struck a deal to include $11 billion for health clinics in the law.
The result has made an indelible mark on American health care, extending the number of people served by clinics from 18 million before the ACA to an expected 28 million next year.
As one would expect, the program was largely met with plaudits from patients and public health experts, but it has also won praise from even the biggest Obamacare critics on Capitol Hill. In letters I obtained through multiple record requests, dozens of Republican lawmakers, including members of the House and Senate leadership, have privately praised the ACA clinic funding, calling health centers a vital provider in both rural and urban communities.
To Sanders, the clinics have served as an alternative to his preferred single-payer system. Community health centers accept anyone regardless of health, insurance status or ability to pay. They are founded and managed by a board composed of patients and local residents, so each center is customized to fit the needs of a community. No two health centers are alike.
In rural North Carolina, ACA-backed health centers now provide dental and nutrition services, while in San Francisco, the clinics provide translation services and outreach for immigrant families. In other areas, they provide mental health counseling, low-cost prescription drugs, and serve as the primary care doctors for entire counties. They have also served as a platform for innovation, introducing electronic medical record systems and paving the way with new methods for tracking those most susceptible for heart disease and diabetes.
Author John Dittmer, in The Good Doctors, traces the history of the modern health center to the civil rights activists who ventured into the South during the early 1960s. The activists were seen as outside agitators, and local doctors refused to treat them. As a solution, volunteer bands of physicians were organized by a group called the Medical Committee for Human Rights.
Beyond treating the civil rights workers, the MCHR physicians were struck by the stark disparity in health services, encountering many African-Americans who had never seen a doctor before in their lives. The activist physicians returned to the South after the “Freedom Rides” to found a small clinic in Mound Bayou, Mississippi, in the heart of the Mississippi Delta, and by doing so, began a movement to launch health clinics across the country in underserved areas. Winning support from President Lyndon Johnson’s Office of Economic Opportunity, the clinics became part of Johnson’s “War on Poverty.”
Over the years, health centers have gained support on a bipartisan basis. Health centers secured critical funding from the efforts of the late Sen. Ted Kennedy, D-Mass., and both George W. Bush and John McCain campaigned on pledges to expand them. . .
Continue reading. There’s quite a bit more to the article.