nursinghomeA 100-year-old woman is strangled by her roommate, but a lawsuit against the nursing home gets blocked from court. Another nursing home dodges a suit when a 94-year-old patient suffers an unexplained and fatal head wound. An Arizona facility manages to duck a negligence suit when an elderly Alzheimer’s patient endures two sexual assaults in two days in a nursing home. How can these and other similar efforts to seek justice for the aggrieved  fail to find their day in court?

Federal regulators, with oversight on 1.5 million nursing home residents and more than $1 trillion in Medicare and Medicare funding, finally have stepped in with new rules in answer. Nursing homes will now be barred from forcing arbitration onto their customers. That means that nursing homes will no longer be able to push significant problems involving negligence, elder abuse, sexual harassment, and even wrongful death, out of public view and the civil courts, and into the private system of arbitration.

This is a big win for consumers.

Food_and_Drug_Administration_logo.svgIt may sound like inside baseball but it’s not. It’s a critical aspect of how federal bureaucrats who work for us, the taxpayers, need to stop advancing their own agendas, and how they should stop trying to control not only important medical, scientific, and regulatory information but also the public conversations that are supposed to ensue from it. The lessons to be learned here also could apply to prestigious research institutions.

Scientific American deserves credit for poking in the nose some potentially important sources in the federal Food and Drug Administration, other U.S. agencies, and those renowned research institutions for using “close-hold” news embargoes, and exclusive releases of big materials to select journalists. To be sure, embargoes are common, and for agencies and institutions they can be necessary to ensure they get their information out, at once, in a timely fashion, with appropriate resources and staffing, and, actually, in the fairest possible way.

But as the respected journal points out, these practices have gone beyond separating the working press into cool kids and not. Instead, these have become tactics to bully and arm-twist journalists to ensure one point of view, that of the agency or institution, is favored─at least in the crush of a particular news cycle. Unlike other news embargoes, in which journalists voluntarily agree to not publish information until a given time, close-holds also restrict them from seeking advance comments or other points of view. With tight deadlines and a 24/7 news cycle, unless reporters can gather some information in advance, they can’t get it in time to include in stories about an agency or institution information release under “close hold.”

aanningA conscience-stricken surgeon in South Dakota has publicly confirmed one of the great frustrations for patients pursuing medical malpractice claims after they have been harmed: He says doctors are too willing to lie in court to protect themselves and colleagues, as he did two decades ago in a case involving a partner in his practice.

Dr. Lars Aanning says he no longer could live with his lie. Because he is 77, retired, and cannot be subject to colleagues’ retribution, he decided to ‘fess up, and to help attorneys who represent injured patients. Aanning says he does not know whether his false testimony was decisive in his partner’s lawsuit. But he confesses that he knew his colleague’s patient had suffered because of the treatment this stroke victim received. He also had had doubts before about his partner’s work.

He tells a reporter for Pro Publica, the Pulitzer Prize-winning online investigative site, that he knew at the moment he uttered his untruths that his lying flew in the face of everything he thought he stood for. But he says, “I did it as a matter of course. And I did it because there was a cultural attitude I was immersed in: You viewed all attorneys as a threat and anything that you did was OK to thwart their efforts to sue your colleagues. I just accepted that as normal. It wasn’t like, ‘I’m going to lie. It was, ‘I’m going to support my colleague.’ ”

abbott-300x200New information has surfaced about Big Pharma’s relentless  campaign to sell the public on prescription, opioid painkillers─powerful, addictive drugs whose wide availability and abuse now has become a killer scourge that claims almost 80 Americans’ lives each day.

These latest news reports, especially focusing on OxyContin, one of the most potent and abused painkillers, also paint an ugly picture of doctors as easy marks, all too willing to risk their patients’ well-being in exchange for doughnuts, lunches, and cheap gift certificates at book stores.

Kudos first to Stat, the online health information site, for following up the commendable efforts by West Virginia officials to hold two drug companies, Purdue Pharma and Abbott Laboratories, accountable for millions of dollars in harms that abuse of OxyContin caused after the small, poor state was flooded with the prescription painkiller. Neither Purdue nor Abbott admitted to any wrongdoing in settling a lawsuit with West Virginia, which asserted that overzealous marketing by the two companies had contributed to the state’s painkiller epidemic. Purdue agreed to pay $10 million to the state in 2004 to settle the suit.

coughThe news circus about the health of presidential candidates gives us a good excuse to mention a smart preventive care measure for both  very young and older Americans:  vaccination against pneumonia.

Yes, there are many different kinds, both of the illness and the preventative inoculation. Pneumonia, for which there are at least 30 causes, can be traced to infection by bacteria, virus, or fungi. There are at least two types of anti-pneumonia vaccines, one for kids and the other for those 65 and older.

Pneumonia, combined with the flu, claimed almost 57,000 lives in the United States in 2013, and hospitalized more than 1 million.

suppliesYes, the good news is that the number of Americans without health insurance has fallen to new lows. But it’s also true that employers, who still provide the bulk of health care coverage in this country, have shifted increasing amounts of the cost burdens to their workers. With Americans footing the bill for one of the priciest health care systems in the world, one which takes up 18 percent of the Gross National Product, that means every effort to wring out excess costs or to improve efficiencies is worth noting, including:

  • The waste and pollution caused by needless discarding of unused surgical supplies. The nonprofit Kaiser Health News service has put out an excellent report, looking at researchers’ reviews of 58 neurosurgeries at the University of California San Francisco Medical Center. They found that, on average, every neurological surgical procedure resulted in $1,000 in waste, a cost that could multiply to almost $3 million in just that the one department. Further, the too casual discarding of unused, unopened surgical supplies results in tens of thousands of pounds of waste each year that must be specially handled and disposed of at extra cost. It also adds to the burdens at public landfills. The UCSF researchers, who have published their results in the peer-reviewed Journal of Neurosurgery, say there are ways to curb wasteful practices. Scrub nurses were less inclined to chuck expensive, reusable surgical supplies simply if they knew someone was watching. Hospitals also can let doctors know how their per-operation costs on equipment and supplies compares with peers, the researchers said, adding that administrators also may wish to develop and scrutinize equipment and supply orders for surgeries.
  • Millions of dollars in spending on low-value medical services. Researchers at the RAND Corporation, rather than focusing just on excessive spending in public programs like Medicare, turned their sights on patients with insurance and their expenses for services that various analysts and groups say don’t produce much benefit. Although the numbers of these procedures, as reflected in more than 1 million insurance claims analyzed, weren’t that high, 28 of the services produced almost $33 million in dubious costs. The payments went for “hormone tests for thyroid problems, imaging for low-back pain and imaging for uncomplicated headache. The greatest proportion of spending was for spinal injection for lower-back pain at $12.1 million, imaging for uncomplicated headache at $3.6 million and imaging for nonspecific low-back pain at $3.1 million.” A lead investigator in the study, published in the peer-reviewed  JAMA Internal Medicine, said, “Our findings add evidence to the notion that reducing overuse of medical procedures could improve quality while reducing spending.

Raw_cane_sugar_lightWe’ve seen this playbook before, and it’s never pretty how wealthy industries can distort scientific research and harm the public health for decades. Think tobacco and cancer, oil and climate change, football and brain injury. Now: sugar.

Big Sugar secretly paid influential experts, steered and reviewed their inquiry, and, as a result, American health policy at a critical point in the 1960s–and since–has emphasized the role of fats and downplayed sugar’s harms in the rising incidence of heart disease, researchers have found.

This influence-peddling involved then-prominent (now dead) Harvard nutrition experts and the highly respected New England Journal of Medicine (NEJM). The prevailing ethics then differed. Authors were not required by medical journals to disclose conflicts of interest, as they are supposed to now.

prostateA  study involving more than 80,000 men followed for 10 years gives some important clues, but no final answers, on what patients with a diagnosis of prostate cancer should do. It’s long been a puzzle because prostate cancer is one of the most common and deadliest cancers for men, yet in many cases it’s so slow to grow that men die with, not from, prostate cancer.

Here’s the bottom line, which the researchers emphasized needs to be continued for an even longer time for its findings to be more authoritative:

At a median of 10 years, prostate-cancer–specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring.

Now that the Labor Day holiday has passed, it’s a perfect time to remind youngsters and their parents: Sports are supposed to be leisure and pleasure activities. And they need to be safe.

Ryan Basen, a tutor to kids and a medical writer, has put together a pointed piece in the Washington Post about youngsters and athletic over-use. He cites facts, scientific studies, and his own painful experiences to chide parents gently about the widespread mania for youngsters to spend huge chunks of their lives in games that not only may not be fun but painful and harmful.

ICUThe spots in hospitals where patients in the direst shape receive specialized treatment are themselves in need of urgent care, experts say, explaining that antiquated intensive care units (ICUs)

contribute to needless harm. But how exactly to yank them and the therapies they provide into the 21st century?

Usha Lee McFarling, a Pulitzer Prize winner, examines ICU reforms for the online health news site Stat, finding that these crucial and “heroic” hospital facilities fundamentally have changed little in a half century, although they now are jammed with new technology and devices. They serve almost 6 million Americans in grave condition, but in them, she says, “studies show serious and sometimes fatal medical errors are routine. And a recent review published in the journal Critical Care found no major advances in ICU care since the field’s inception in the 1960s.”

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