AU Blogspot

             Thanks to Kimberly Hurst for permission to use this Photo.

The following Wall Street Journal article should be of great interest to our medical students.  Insurance companies, never on anyone’s sympathy list, have long been complaining that they should not be responsible for paying out insurance claims related to hospital errors.  This position in itself is reasonable; however the issue also contains elements of a slippery slope argument.  Instead of simply refusing accountability for grave errors (mistaken operations, infected blood transfusions, etc.)—industry experts foresee private insurers, much like Medicaid, gradually widening the definition of “errors” to include non-coverage of patient infections alledgedly contracted during a hospital stay.  The CDC states that approximately 99,000 deaths occur annually due to hospital-based infections!  With added pressure being placed on them from the insurance industry, hospitals find themselves under fire for not improving their health safety standards.  In response, hospitals say that increased regulation will only increase health care costs for the patient and further complicate a hospital system already drowning in bureaucracy. 

The medical billing implications are also intriguing.  Due to dense and often confusing medical billing language, many patients are more often than not unaware that they are being billed for hospital errors.  Now that private insurers are beginning to adopt the Medicare model, patients may well be more informed about what exactly is on their medical bill, but hospitals will ultimately have to find new ways to offset the added costs they absorb to raise their infection prevention standards.  As this story continues to unfold, I have a feeling that the patients’ best interests will get lost in the details. 

Ryan Rode
Interactive Services Manager
Ashworth University School of Health Care       

           Thanks to Kevin Trotman for permission to use this Photo.

I wrote a blog entry on this topic yesterday, then deleted it, as it wasn’t very nice. Kevin, MD’s Dr. Pho has covered 75% of what I wanted to say on his blog today (nicely), here; read his blog entry then come back here for the rest of what I wanted to say:

Glenn Beck’s hospital horror story is getting some attention. Apparently, he had a surgical procedure with marked post-op pain. As physicians tried to control his pain with increasing doses of narcotics, he suffered adverse reactions as a result.

This is one of those amazing occurrences in medicine that makes all of us in Emergency Medicine alternately furious and incredulous, the “Just go to the ER” from a physician who knows the patient much better than the EM doc will, knows what outcome they want, what the patient will need, but cannot be bothered with the 10 minutes of administrative time it’d take for the direct admit to happen. This is what Mr. Beck should have had in the first place, and then a lot of his problems / complaints wouldn’t have happened. He didn’t need the ED, he needed his doctors to take care of their patient.

Mr. Beck was operated on that day in the same facility he was sent back to for re-admission, after having clearly been identified by the anesthesiologist on the case as having significant problems with pain control. (more…)

                   Thanks to Bethany for permission to use this Photo.

Last week, I appeared on a four-person health care panel that was televised in New Hampshire.  The panel included a conservative who surprised me by arguing that the difference between the progressive candidates’ proposals for health care reform and the conservatives’ position on health care just isn’t that great. Looking at the candidates’ proposals, I disagreed.  Put simply, the conservatives would like to make government smaller. They want to “outsource” many of government’s jobs to the private sector. They tried to privatize Social Security, and they have partially succeeded in privatizing Medicare by paying private insurers a steep premium to take care of seniors under Medicare Advantage. (See my post about the high cost of the program here).

Finally, the vote on SCHIP split along conservative/ progressive lines, with conservatives voting against expanding SCHIP. As President Bush explained, more funding for SCHIP would expand the government’s role in our health care system. The progressives who voted for SCHIP believed that government should expand, as needed, to provide a safety net for its citizens. If the market cannot provide affordable, high quality health care for all Americans, then the government must step in. (more…)

 
                    Thanks to Ali J for permission to use this Photo.

Health 2.0, like its’ older cousin Web 2.0 and uncle Web 3.0, is getting more and more attention. My colleague Bonnie Andersen pointed out the December 11 Modern Healthcare article, in which the magazine describes the three most important principles of what a Health 2.0 company or application is. 
 
The first principle is the software of a Web 2.0 company has to be Web-based, has to provide a service and that service has to be structured  so that the more people use it, the better it becomes. An example is eBay; as more and more buyers and sellers participate, the broader the eBay  market becomes, which creates more value to the customer. 
 
The second key principle is “harnessing collective intelligence,” which  also is referred to by others as “the wisdom of crowds.” To avail  themselves of this wisdom, Web 2.0 developers must create applications that  are dynamic, with user participation designed into the systems, so that  participation itself becomes an integral part of making the underlying  database more valuable. 
 
The third principle, “Data is the next ‘Intel inside,’  notes that  specialized data, enhanced through analysis performed by the service  provider as well as by the contributions of service users, becomes the core  asset of a Web 2.0 company. Amazon wish lists, for example, are aggregated by Amazon and used as buyer’s guides.
 
Matthew Holt of the Healthcare Blog and co-founder of the Health 2.0 conference is looser in his definition, placing the qualifying emphasis on whether the service or application promotes the healthcare experience as an “ongoing process” rather than a “series of episodic events.”

(more…)

Many parents have said yes. David Healy, a Scottish psychiatrist, prompted by those stories, did a small experiment in which undepressed persons took anti-depressants. About 10% of them started having suicidal thoughts. Drug companies and the University of Toronto (where Healy had been offered a job) reacted very badly to this information, as Healy describes in Let Them Eat Prozac. An article in the latest issue of the American Journal of Psychiatry by David Leon, a biostatistician on the FDA oversight panel, describes why he voted to extend a warning about this from children (< 18 years old) to young adults (18-24 years old). This was the main data:

What’s shown is the odds ratio for a report of suicide ideation or behavior, comparing those who got anti-depressants with those who got placebos. (more…)

                 Thanks to Gianni for permission to use this Photo.

Daniel Carlat, of the Carlat Report, has an article in the New York Times Magazine.  It’s six pages long, and decidedly anti-Pharma.  But Daniel Carlat isn’t from New York– so why would he have an article published there?

You say: well, where he’s from has nothing to do with it, the New York Times is publishing it because of what he says.

Exactly.

His article, well written and persuasive, stands as is, undisputed because there is no forum in which to dispute it.  I guess it would be nice if the Times would allow me to write an op-ed– you know, in op to the ed– but I guess this blog will have to do.

Carlat is wrong, very wrong, not because he is factually incorrect about his target, but because his target is a straw man.  The problem isn’t Pharma.  It’s doctors.

The article, called Dr. Drug Rep, chronicles his introduction into the world of lecturing for drug companies– a company hires you to give a talk about a topic or drug to a bunch of doctors– and the effects of the lecturing on doctors and himself, and then his pulling out.  For context, Carlat is a fairly famous psychiatrist blogger who is both a sort of watchdog of Pharma, as well as a source of information about psychiatric drugs. 

The general message is that Pharma softly manipulates doctors to act as proxy drug reps, which in turn lends credibility/celebrity endorsement to the Pharma message, and thus influences other doctors to prescribe the medicine.  Ok, I hear you.  I have no beef with Carlat, his point is not unique.

But break it down:

So we don’t want doctors lecturing about the drugs.  Okay.  Well, who do we want?  More reps?  Here’s where it all falls apart, and I defy anyone to contradict me: doctors aren’t studying these drugs on their own. (more…)

                 Thanks to Natalie for permission to use this Photo.

We Americans are proud of our work ethic. We work longer hours, and more productively, than any other nation. Our industriousness has long been cited as a source of strength of our economy—but it just might be a source of some of our health care woes as well. 

According to a just-released study from Wake Forest University, professional flexibility is an important contributor to better health. Employees at all levels who have, or feel they have, more job flexibility (e.g. the ability to work from home, choose their hours, etc.) engage in healthier behavior than those that don’t. The study found that employees with flexible schedules exercised more, attended more employer-sponsored health classes, were more likely to describe themselves as living a healthy lifestyle, and reported getting more sleep. When the researchers checked in a year later, they found that as job flexibility improved, so did healthy habits: more flexibility meant more sleep, more health classes, and a healthier lifestyle.

This study deserves attention. Changing behavior is the single most powerful way to prevent health problems. As experts from the Robert Wood Johnson Foundation noted in a Health Affairs article earlier this year, “behavioral issues represent the greatest single domain of influence on the health of the U.S. population,” with 40 percent of early deaths in the U.S. due to behavioral patterns. Anything that promotes health behavior needs to be seriously considered as a strategy for making America healthier—and by extension, health care costs lower. 

Obviously, somehow ensuring that everyone in America had more flexible hours wouldn’t cut early deaths by 40 percent. And there’s no guarantee that more flexible hours will translate into better sleep, more exercise, or more education on a national scale. Any movement for universal job flexibility would have to be coupled with a concerted effort to translate free time into healthy time. (more…)