spinal cordFederal auditors have found that 80 percent of Medicare spending in a recent year on chiropractic care−some $359 million−was medically unnecessary. The federal insurance program for senior citizens should not have thrown taxpayer dollars at chiropractors to treat strains, sprains, or joint conditions, the Department of Health and Human Services’ Office of Inspector General says.

Its auditors, reporting on 2013 claims, said Medicare should impose limits on how often seniors can receive chiropractic care, which they said became excessive after a dozen visits; after 30 sessions of treatment, the federal watchdogs said, patients were receiving unnecessary care.

The chiropractors’ association denounced the audit and the proposed curbs on their practitioners’ care. The acting director of the Centers for Medicare and Medicaid Services resisted the recommendations for caps on chiropractic treatment, noting the absence of cited evidence and differences in individual patients. The agency noted that it has tightened its rules on chiropractic claims, including requirements soon to take force that will require advance approval for certain kinds of this care.

prof-Madris-glasses-crop-2Instead of acting as a tough federal watchdog that protects and informs patients about problems with medical devices−from heart valves to drug pumps−the federal Food and Drug Administration all too often has served as an industry lap cat offering late, lax oversight in reporting safety woes, a new report finds. The Minneapolis Star-Tribune and former agency official Madris Tomes (photo right) deserve credit for blowing the whistle on the gaping bureaucratic loophole that lets device makers report problems almost at their leisure, and to do so in a way that hides issues from public view.

By law, the paper says, makers are supposed to file safety incident reports with the FDA within 30 days of occurrence. But the agency not only fails to enforce that requirement, it has created a process of Orwellian double-speak, allowing “retrospective reporting.” Device makers in this process tell the agency about hundreds of thousands of safety incidents, sometimes years after they occurred. Further, the FDA allows the companies to detail the incidents, in some cases tens of thousands of them, in confidential reports. The only notice the public gets is via terse summaries, “marker reports,” of the much longer documents.

Tomes, since leaving the agency, has created a search engine, Device Events, that helps outsiders track agency information on medical devices’ performance. Using that tool, it still took Star-Tribune reporters almost a year to pry from the FDA information barely hinted at in marker reports.

Just how rapacious can Big Pharma be?

relistorMakers hype more drugs as nation faces opioid drug abuse epidemic

  • In the face of an epidemic of opioid painkiller abuse, the drug industry’s answer appears to be: push even more pills on the public. The Washington Post notes that “six in 10 American adults take prescription drugs, creating a vast market for new meds to treat the side effects of the old ones. Opioid prescriptions alone have skyrocketed from 112 million in 1992 to nearly 249 million in 2015, the latest year for which numbers are available, and America’s dependence on the drugs has reached crisis levels. Millions are addicted to or abusing prescription painkillers such as OxyContin, Vicodin and Percocet.” Drug makers’ response has been to “inundate” Americans with advertising, marketing, and promotions of new medications, including sky-high priced Super Bowl commercials. Some of the add-on meds assist in painkiller overdoses, and others provide alternatives that might ease addictions. But makers also are hyping drugs like Relistor and Movantik to deal with opioid side-effects like constipation. As the paper observes, “By promoting opioid-induced constipation as a condition in need of more targeted treatment, critics say the drug industry is creating incentives to maintain the painkillers at full strength and add another pill instead.” Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, says drug makers, by addressing small woes with painkillers, not only makes them more acceptable and increases their use, they increase their profits. He says added meds turn patients’ worth to Big Pharma from a few hundred dollars to several thousand dollars a month. “The pharmaceutical industry literally created the problem” of opioid induced constipation, Kolodny said. “They named it, and they started advertising what a serious issue it is. And now they’ve got the solution for it.”

heatercoolerPost-op heart surgery patients who experience night sweats, muscle aches, weight loss, fatigue, or unexplained fever should contact their doctors, stat, federal officials say. They’re warning that a medical device, designed to keep organs and blood at a constant temperature, was contaminated with nontuberculous mycobacterium (NTM). Officials already have confirmed more than two dozen NTM infections in open heart patients, and thousands more may be at risk.

The federal Centers for Disease Control and Prevention flagged the potential patient risks linked to the Stöckert 3T, temperature-regulating surgical devices made by LivaNova PLC (formerly Sorin Group Deutschland GmbH).

Temperature-regulating devices are common in the 250,000 open heart surgeries performed annually in hospitals, officials say, and 60 percent of the procedures involve the German-made model. NTM infections may not develop immediately, and some cases were confirmed as many as four years after surgery. They typically are not fatal but can be problematic for immune-compromised patients, such as many open heart patients are. They respond well to antibiotics if detected.

Just as patients are unwell and struggling, their well-intentioned doctors may confront them with difficult choices about their care. They often do so with daunting data, and hard to decipher numbers that don’t really answer the vital question: How well does this treatment work, especially for me?

Kudos to two Maryland experts, internist Andrew Lazris, and environmental research Erik Rifkin, for their effort to assist patients and caregivers to “reexamine the usefulness of cancer exams, cholesterol tests, osteoporosis pills, MRI scans and many other routinely prescribed procedures and medicines.” A tip of the hat, too, to the Kaiser Health News service in tapping a useful technology−online video−to illuminate exactly what the experts are up to.

adderallIf aliens beamed down from another planet, how shocked might they be by modern patients’ willingness to ingest crazy stuff in the name of their health or well-being? Is it surprising or distressing that in the 21st century so many patients swallow so much hokum and downright dangerous thinking?

Let’s start with an excellent but deeply distressing New York Times Sunday Magazine story about “Generation Adderall,” a painful dissection of how many young people have become dependent, even addicted, to drugs that their parents started them on, in the name of improving their focus and academic performance. The author reports that Attention Deficit Hyperactivity Disorder, or ADHD or even shorter ADD, has risen as a diagnosis for young people, increasing from 3 to 5 percent of American school kids in 1990 to 11 percent now. The remedy for this, of course, has been prescribing drugs:

In 1990, 600,000 children were on stimulants, usually Ritalin, an older medication that often had to be taken multiple times a day. By 2013, 3.5 million children were on stimulants, and in many cases, the Ritalin had been replaced by Adderall, officially brought to market in 1996 as the new, upgraded choice for ADHD—more effective, longer lasting.

38_Special_mushrooming_side_viewA lethal epidemic is sweeping Baltimore neighborhoods, costing taxpayers millions of dollars, as well as demoralizing caregivers who struggle with its casualties daily. Researchers, tragically, are barred from developing detailed data about this scourge to try to curb its increasingly deadly harm.

Kudos to the Baltimore Sun and reporter Justin George for investigating for a year the gun violence that torments the city, sending at least 200 patients to area hospitals already just in 2016. The Sun says hospitals in the poor city have spent in five years more than $80 million caring for patients involved in gun crimes. Hospitals have seen their gunshot caseload double, and the costs of this care increase by 30 percent. Taxpayers end up footing most of the bill under Medicaid, the federal-state insurance for the poor.

The Sun’s multi-part series looks at gun violence from many aspects but the violence’s effects on the city’s health care is tragic and distressing.

elexDutiful sons and daughters may need to see their parents, uncles and aunts, and grandparents, if nothing else to shut off their cable television news, turn off the talk radio, yank them off social media, and put down their newspapers and magazines. That’s because the American Psychological Association warns that an onslaught of media coverage, in a 2016 U.S. presidential campaign remarkable for its ugliness, is contributing to unhealthy stress for us all, especially older folks.

The association bases this claim on its annual survey, conducted by Harris Poll, of more than 3,500 adults older than 18 and living in the United States, with 52 percent of respondents saying the Hillary Clinton vs. Donald J. Trump race is a “very or somewhat significant source of stress.”

The dark campaign stresses Democrats and Republicans almost equally, and Americans’ discomfort is “exacerbated by arguments, stories, images and video on social media that can heighten concern and frustration, particularly with thousands of comments that can range from factual to hostile or even inflammatory,” the association reports.

skin“Skin to skin” therapy? That was the line item charge that appeared on the hospital bill for a young couple, and the dad decided to check it out. What he found has blown up across the Internet.

It turns out that the Utah parents were charged $ 39.35 by their hospital just so the new mom and dad, just after the C-section delivery of their son, could have their baby placed between her neck and chest. There, proud pops took the requisite newborn pictures.

Only later, as part of $13,280.49 tab for their son’s delivery, did the couple see the skin to skin charge. They posted the bill on a popular online site, where it drew more than 11,000 comments.

death-certificate-state-by-state-default-750_50California regulators have reversed themselves and decided to require hospitals to report outbreaks of “superbug” cases, rare infections that also can prove deadly. At the same time, officials in the Golden State haven’t moved to increase the information disclosed on death certificates−data that advocates suggest would give the public clearer outlines of just how severe a problem hospital-acquired infections have become.

Kudos to the Los Angeles Times, which delved in a recent front-page investigation into the dearth of information disclosed on death certificates, especially about hospital-acquired infections. The paper detailed how a Los Angeles area patient had contracted, while hospitalized, a rare carbapenem-resistant enterobacteriaceae or CRE infection. This superbug resists treatment with an array of antibiotics, eventually killing half those it afflicts. Its outbreaks are a huge concern for public health authorities.

But, The Los Angeles Times said, hospitals had cried “poor me” to the state, saying it required extensive resources to monitor and report CRE outbreaks. The death certificate for the patient with the CRE infection, the newspaper said, listed a perforated ulcer as her cause of death. Her family was outraged because they had urged Torrance Memorial Medical Center to report a CRE outbreak to the state.

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