oxycontin-150x150Big Pharma stayed in an unpleasant spotlight last week, with developments including:

How OxyContin reformulation may have hiked heroin-related deaths

A  new study has helped to explain the nationwide surge in heroin-related deaths, and how these likely are the unintended consequence of reformulations of OxyContin, a powerful, addictive painkiller. The study by the University of Pennsylvania and the RAND Corp., published by the National Bureau of Economic Research, scrutinized state-level data both on OxyContin abuse and heroin fatalities, which tripled from 3,000 in 2010 to 10,500 in 2014. Areas of highest misuse of the prescription painkiller dovetailed with those where heroin-related deaths spiked.

Edward_Jenner-150x150Donald_Trump-150x150In 1798, Edward Jenner, an English physician, published a small pamphlet that forever changed the course of  medicine. The pamphlet described how vaccinations could prevent infectious diseases. But  more than two centuries after his lifesaving breakthrough, which has sidelined some of the planet’s worst scourges, how is it that a leading physician at one of the nation’s top academic medical centers, a scion of a legendary American political family, and the U.S. president-elect all can raise public doubts — without basis in science or evidence — about modern inoculations and their demonstrable health benefit?

Vaccines, to be sure, carry risks. So do all medical treatments. Some proponents may overstate their effectiveness. Their harms and benefits have been studied extensively by credible experts, and that research continues. It’s published and available, often online for free. What’s beyond issue is that vaccinations protect the public health, and the evidence for their widespread, consistent, and sustained use is beyond debate. For inoculations to reach their maximum effectiveness, it’s vital, of course, that more not less of us get them to build and maintain  “herd immunity.”

We’re almost two decades past the fraud, refutation, and retraction of a rotten medical journal article that utterly misrepresented scientific research about some vaccines. Its harms live on, including when its fabulist views find echoes in a Cleveland newspaper blog post by an M.D. at the notable Cleveland Clinic, or when the incoming leader of the free world engages in another of his dumpster-fire quality meetings with Robert F. Kennedy Jr., both disputing later as to whether it will result in a new presidential panel reexamining vaccinations. The Washington Post underscores that such a panel already exists, and, by the way, Stat, the online health information site, has provided a short, informative look at how the president can affect vaccinations.

price-portrait-300x253The Republican-controlled Senate has launched itself in a late-night session on the path to its long-pledged repeal and replacement of the Affordable Care Act, aka Obamacare. The GOP-controlled House on  Friday the 13th followed close behind.

Lawmakers have chosen a complex parliamentary path. GOP members are expressing confusion about their way forward, even as doubts are being voiced by GOP governors in states where the ACA has expanded health care for the poor through Medicaid. The president-elect has called for swift action — insisting on not just Obamacare’s repeal but also its replacement with an undefined plan that he says will provide health care coverage that’s better than what exists now and for more Americans.

With big, many, and byzantine legislative steps needing to be taken even beyond “repeal,” can the ACA be replaced, too — and with what?

Cattle-300x219What happens on farms in Georgia and Oregon or ranches in Texas and Wyoming has a direct and significant effect on how healthy hospitalized patients stay in Buffalo, Baltimore, or Los Angeles. And now federal regulators have put in full effect a big change to help protect humans’ well-being by ensuring medically important antibiotics don’t get squandered in agriculture, where they’re used mainly to make livestock bigger and more profitable for farmers and ranchers.

Under new federal Food and Drug Administration regulations, antibiotics that are used to treat people and their diseases cannot be fed to animals principally to promote their growth. Before such drugs can be added to feed, a veterinarian now must approve and supervise their use—a new step that will make them more expensive and inconvenient.

Animal consumption of antibiotics has soared in recent years. Even with growing pressure from public health officials concerned that the medications’ germ-fighting capacities are diminishing due to over-use, American farmers and ranchers increased their antibiotic purchases by 2 percent in 2015 versus the year previous, federal data show. Growers pumped 9.7 million kilograms of the valuable bug-fighting drugs into cattle, pigs, and chickens destined for American kitchens and dining tables.

Two health care experts just put out a list of seven questions that Congress needs to answer about its replacement for the Affordable Care Act. The list is simple and useful for all of us in any contacts we have with lawmakers. Here it is:

1. How many millions of Americans will lose coverage?

2. Will people over 55 pay higher health premiums for the same coverage?

3. Will the new plan let insurers charge women higher premiums than men while offering them less coverage?

4. What other services are likely to be cut?

5. Will the new plan let insurers reinstate annual or lifetime limits on coverage?

6. What will happen to the more than 130 million Americans with pre-existing conditions?

7. How much more will those with costly illnesses or injuries have to pay in out-of-pocket costs?

For more details about what the possible answers might be, read the op-ed in the New York Times that this list came from, by Harold Pollack of the University of Chicago and Timothy Jost of Washington and Lee University.

And if any readers of this blog feel moved to pick up the phone and call your Representative or Senator, here’s a website that has a dedicated phone line that will patch you through to the right member of Congress representing you.

Or just call: 866-426-2631.

med-records-300x200In the best of all worlds, none of us will need any time soon to race to a nearby urgent care center or to pop by the retail, walk-in clinics that have sprouted in neighborhood drug stores across the country. But if you do find yourself at one of these “doc-in-a-box” clinics, here is some good advice. A lot of this applies to regular doctor visits, too.

A tip of the hat to Dr. Peter Ubel, who posted recently at Forbes and KevinMD.com, the physician information-sharing site, his suggestions of a half dozen “essentials” that patient-consumers might need to know before a retail clinic visit. He based these on positions taken by the American College of Physicians and published in the peer reviewed  Annals of Internal Medicine.

Ubel says “doc in a box” operations (retail clinics, often staffed with physician assistants or nurses) are suitable for low-level, ordinary treatment for things like poison ivy or sore throat. When patients go to these clinics, they need later to fully inform their doctors about the care they got (see the next paragraph). They shouldn’t take referrals to specialists from staff at walk-in clinics. The facilities are OK for patients who are “relatively healthy,” and who don’t have a “complex medical history,” meaning they lack chronic or difficult conditions. Patients with greater challenges need to see their own doctors, regularly if need be. Ubel calls out his colleagues, noting that if they were more responsive to their patients, or figured out alternatives when they can’t, docs in boxes wouldn’t be flourishing as they are.

peanutsAlthough many of us would like nothing better than to dote on a favorite baby all day long, medical experts have offered some surprising turnarounds and concessions for the new year about what they do and don’t know about infant care-giving.

They have made a 180-degree reversal on their advice to parents on dealing with the rising problem of peanut allergies, while also suggesting that a familiar product may be more useful than thought to combat a common skin woe. And they have said that 90 percent of the medications given to newborns aren’t approved for such uses by the federal Food and Drug Administration.

Feed the baby peanuts, docs now say

obamacare-cartoon-2-a-300x240As the already known complications to its demise have increased by the minute, there may be some detectable pauses in the partisan zeal to give the Affordable Care Act, aka Obamacare, the bum’s rush. That’s because the legislation’s repeal-and-replace proponents — despite seven years and several dozen U.S. House votes  to roll back the ACA — have yet to detail how 20 million Americans who have gotten health insurance under Obamacare will be covered in the days ahead.

Opponents also haven’t explained how they may change the far reach of the ACA, including how the law and the Obama administration have reshaped, and often, improved American health care, for example, by changing entrenched payment practices and forcing greater accountability.

The New York Times, in reviewing the presidential legacy, has reported on what it terms the transformational aspects of Obamacare that also may sustain, no matter the partisan attacks on the attempt to provide broader health insurance coverage. In brief, the paper says Obamacare forced health care in this country to become more data-driven and evidence-based, as well as refocused on patients and their needs. Although some of the major drivers of these reforms, including hefty spending for electronic health records, haven’t hit the high marks advocates hoped for, progress has occurred.

fireextinguisher-211x300They’re likely jammed into many of the toys and electronic gadgets that overflowed the house during the holidays. But they’ve also been linked to sufficient fires that products have been recalled because of them, and some devices with them have even been banned in the nation’s skies. Now federal regulators are warning hospitals and doctors’ offices to beware, too: Their many battery-laden medical carts may burst into flames or explode.

The federal Food and Drug Administration has written to caregivers nationwide with a new caution that, within the last three years, it has received a dozen reports of “smoke, fire, melting batteries, burning, and other hazards” with medical carts. No injuries have been recorded but facilities have been evacuated due to smoke and fire hazards from cart blazes or smoldering, the FDA says. The rolling stations have grown increasingly common so staffers can conveniently dispense medication, or carry equipment related to colonoscopes, ultrasound, and anesthesia machines.

They’re also prized because their electrical sources—lead acid or increasingly lithium batteries—pack the power needed, they’re portable, convenient, and they’re long lasting. But those batteries also can generate a lot of heat, and they have proven problematic in other uses.

Carrie_Fisher_memorial_star-225x300Although advocates ended 2016 cheered by new legislation that increased funding and raised the priority of mental health in the nation’s health policy, the year also closed with stark reminders of how far the United States has lagged in this vital area.

Two separate news investigations have painted dire portraits of how the lack of mental health care has led to criminal violence and killings, while another media probe found disturbing signs that a major hospital chain was too quick to question patients’ mental competency and then to hold them against their will. The deaths of two of Hollywood’s elites—a mother and daughter—also brought to fore the stigma that many still bear due to mental disorders.

Neglect’s huge toll

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