DiceA globally renowned seismologist, weary of recent scaremongering reports that a major fault in California was “locked, loaded, and ready to roll,” offered a pointed scientific evaluation of risk: “You’re about as likely to be shot by a toddler than die in an earthquake,” she observed. She explained that, in geologic terms with earthquakes, imminent can mean centuries, not milliseconds. Further, over the last 100 years, there have been an average of 40 temblor deaths annually in the Golden State; in 2015 alone, toddlers with guns killed roughly that same number of Americans.

Suddenly, the media fascination with an impending seismic catastrophe receded to more normal concern.

This much publicized discussion of risk underscores the private complexity that many patients confront in harsh, short time spans when they get multiple surgeons’ opinions on whether they should undergo major procedures. Why does one surgeon tell a young patient and his family to wait and try a lot of other treatments for his brain hemorrhages but not an operation? Then why does a second neurosurgeon tell them the boy needs a procedure NOW to save his life?

We wrote yesterday about contamination at the pharmacy of the NIH Clinical Center in Bethesda. Other big hospitals, judging by media reports, also may need to look at their pharmacy operations, especially when they compound ingredients together into custom drugs for patients.

A major hospital in a San Diego, Calif., suburb may have exposed more than 7,300 of its patients to infection risk due to contaminated medications served up in a pharmacy compounding lab. State officials fined Paradise Valley Hospital $17,500 not only for sanitary violations found in inspections but also because a hospital executive with oversight over the compounding lab was found to have falsified records; no patients came down with infections at the hospital due to the lab woes, otherwise the hospital could have been fined up to $75,000, state officials said.

And in Seattle, the flagship University of Washington Hospital between May 2014 and October 2015 produced medications for  surgical IVs, cancer care chemotherapy, and even simple injectable steroids for joint pain in pharmacies so dirty that they failed that state’s health department inspections, a TV station has reported.

nihclincenterFederal officials have decided to sweep out the executive ranks at the flagship hospital of the National Institutes of Health in Bethesda, this after a blue-chip investigating committee rebuked the institution and declared that research concerns there had wrongly taken precedence over patient safety.

Initial reports about the NIH Clinical Center, as I wrote recently, had suggested that systemic changes were required at the venerated and sprawling facility, particularly after disturbing reports surfaced about neglect and unsanitary conditions in its pharmacy operations. Officials first spoke just of creating a new, external oversight body, and an office to monitor quality and safety concerns.

But, as the Washington Post since has reported, the NIH’s chief has decided to “replace the hospital’s longtime leadership with a new management team with experience in oversight and patient safety, similar to the top structure of most hospitals. He is recruiting for three new positions: a chief executive, a chief operating officer and a chief medical officer. … [He] wants all three to be physicians, and he wants them in place by the end of the year.”

Who can you believe these days for health news?

  • A biotech company that promised the stars when it comes to one of the most common medical diagnostics—it promised cheaper, faster, more convenient blood testing—has, instead, retracted tens of thousands of its results that doctors and patients had depended on for two years. The Wall Street Journal (its story is behind a paywall) first reported this gaffe by Theranos. The paper has dogged the gee-whiz Silicon Valley start-up that Wall Street adored, even as it kept hidden the medical technology that it asserted was such an advance. Its claims fell apart as journalists and regulators, especially from the Centers for Medicare and Medicaid Services, demanded to see the data behind the hype.

In medical science as well as advocacy, the anecdotal has its limits as evidence. But nothing illustrates the complexity, headaches, and heartaches of modern health care like real people’s stories, such as these recommended reads:

110922_ralph_nader_ap_605Americans have been brainwashed into disbelieving a fundamental truth about their legal system: Lawsuits actually are good for the country. They aren’t as costly nor as numerous as conventional wisdom holds. And they play a crucial role in keeping in check the greed and harm that business interests otherwise might inflict with impunity.

Says who? These are some of the trenchant views newly outlined in a recent magazine cover story by Ralph Nader, one of the nation’s preeminent consumer advocates. It’s true that some partisans sneer at him these days, faulting his attacks on big money politics and blaming his quixotic third-party candidacy for the razor-thin loss by Al Gore 16 years ago.

But lest history forget, Nader’s crusading, particularly with auto safety, has resulted in sweeping reforms that have saved tens of thousands of lives; he has saved American consumers countless sums with his battles against rip-offs by banks, insurers, and other big businesses.

hobson-theranos-1-rkIt sounds so simple that many Americans, especially with modern DIY  technology, may want to try: To get healthier, why not go out and get every possible diagnostic test done? Especially if all it takes is a drop or two of blood: Wouldn’t this increase early detection of disease and make for quicker treatment and better health?

Think again, please. This is a more nuanced issue with potentially significant cost implications and health risks from inevitable test foibles and inaccuracies, as some nifty reporting by the numerically oriented folks at the online site 538 have shown.

They have joined in the increasing media take-down of Theranos, a gee-whiz company that became a Wall Street favorite. The firm ─which is under regulatory fire for hyping its product─not only claims it has proprietary processes that will make blood testing faster, more convenient, and cheaper, it also says that its work-ups should become more ubiquitous. Theranos says patients who undergo more blood tests might learn about possible diseases sooner and get treated better.

Here are some developments worth watching in the nation’s battle against the epidemic of opioid drug misuse that killed 28,000 Americans in 2014 alone:   

CONGRESS ACTS: Congressional negotiators now must confer to determine which parts of House and Senate measures to combat opioid drug abuse will go forward. The House just passed a package of bills, while the Senate approved its measures a month ago. A key difference dividing the two chambers is funding, with Democrats complaining that GOP lawmakers, particularly in the House, aren’t putting up new and real money for the anti-drug efforts to be effective. President Obama has sought $1.1 billion to combat the abuse of heroin and prescription, opioid medications.

cropped-stat-logo-tealJUDGE UNSEALS OXYCONTIN FILES: A state judge in Kentucky has rejected a drug maker’s attempt to keep sealed court records from a recent lawsuit over the marketing and abuse of the powerful opioid painkiller OxyContin. The online health news site Stat asked the court to open the records, arguing that the public had a huge need to know how OxyContin’s maker had so aggressively sold the drug, leading to widespread deaths and addiction, particularly in poor parts of the state. The drug maker settled with Kentucky, paying $24 million over allegations it illegally promoted OxyContin; the citizens of Kentucky had the right to know details of the case to decide if that settlement was fair and reasonable, the judge ruled in unsealing the court records. A key document from the Kentucky files that likely will attract considerable attention is sworn testimony from Richard Sackler. He’s a member of the family that owns the maker of OxyContin and is the firm’s president. He’s also an MD who was deeply involved in OxyContin’s development and marketing.

vapingBig Tobacco has gotten a major kick in the pants over one of its insidious means to hook a new generation on harmful habits. The federal government says it will regulate the booming e-cigarette business, banning sales of the products to those younger than 18 who “vape” and requiring photo IDs for e-cigs’ purchase by consumers younger than 26.

After long discussion about the potential harms of increasingly popular e-cigarettes, vaping, pipe smoking, and hookahs, the government has decided to exert its authority over them as it has for decades over cancer-causing cigarettes, starting in 90 days and with hundreds of pages of new rules.

Makers of e-cigarettes also must submit products for federal review before marketing them. They must provide ingredient lists and describe potential health risks. The costs for such reviews are estimated to be roughly $1 million per product, which vaping advocates said would put a major crimp in what has been a booming, largely unregulated business. But Big Tobacco foes said it was past time for health’s sake that vaping had oversight, particularly to protect the young.

Flag_of_South_Dakota.svgSevere diabetics, the blind, and the mentally ill all too often get sent to sterile and restrictive group or nursing homes by South Dakota officials who can’t seem to find other care options because they discriminate against thousands of the disabled, the federal government says.

The Justice Department is investigating the state under federal laws affirmed by the U.S. Supreme Court. As the New York Times reports, the feds aim to protect the disabled from needless confinement in highly regimented group or nursing homes because:

[A] 1999 Supreme Court decision, Olmstead v. L.C. [held] that, unless a nursing home is medically necessary, people have a right under the Americans With Disabilities Act to receive care without being segregated from society. Advocates for the disabled have compared that ruling to Brown v. Board of Education, which declared racial segregation in schools unconstitutional.

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