Articles Posted in Infections

Mick_Mulvaney_Official_Portrait_113th_Congress_cropped-249x300The  Trump budget for the federal government would be a huge step back from investment in medical research with consequences for many years in progress on promoting health and fighting disease.

The budget announcement, tilted so far toward guns over butter, proved so challenging to even members of Trump’s own controlling party that lawmakers hastened to underscore that Congress, and not the chief executive, theoretically, holds  the nation’s purse strings.

The president would boost allocations for the military by more than $50 billion, and significantly increase spending for homeland security, with billions for his proposed border wall as well as more customs and immigration agents nationwide. He would gut almost 80 federal programs, providing support for everything from the arts and public broadcasting to home weatherization, rural economic development, legal services for the poor, and meals on wheels food services for the old and sick.

cdc-logo-300x226When it comes to the nation’s health, the Trump Administration and the GOP-dominated Congress seem determined to prove they know how to do penny-wise and pound-foolish. They’re amply demonstrating this with proposed slashes in the nation’s basic budget for public health. They’re calling for a $1 billion cut for the Centers for Disease Control and Prevention, notably in the agency’s funding to combat bioterrorism and outbreaks of disease, as well as to battle smoking and to provide critical medical services like immunizations. Their target is the Prevention and Public Health Fund, set up under the Affordable Care Act, aka Obamacare. With the ACA under fire by partisans who want to repeal and replace it, the fund was already imperiled. GOP lawmakers, determined to cut domestic spending, seem disinclined to come up with substitute sums.

Andy Harris, a Maryland Republican congressman, physician, and House appropriations health subcommittee member, has been quoted as calling the public health money, “a slush fund.” He argued that, “It’s been used by the secretary [of health and human services] for whatever the secretary wants. It’s a misnomer to call it the Prevention and Public Health Fund, because it’s been used for other things, and it’s about time we eliminated it.”

The Obama Administration did embarrass Congress by tapping the fund to provide emergency aid last summer to Florida, Puerto Rico, Hawaii, and other states battling tropical infections, including Zika and dengue fever. Congress took a long recess vacation, as states clamored for help for mosquito eradication and vaccine development to deal with Zika, a virus that can cause severe birth defects and other harms.

hospital-300x209When a giant institution like MedStar Georgetown University Hospital announces it will spend more than a half-billion dollars to improve, rebuild, and expand its facilities, few of us blink.

That’s because we know that hospitals, in general, are “among the most expensive facilities to build, with complex infrastructures, technologies, regulations and safety codes,” observes Druv Khullar, an M.D. and M.P.P. at Massachusetts General and Harvard Medical School.

Khullar, however, goes on to write in a trenchant Op-Ed column in the New York Times that, “evidence suggests we’ve been building [hospitals] all wrong — and that the deficiencies aren’t simply unaesthetic or inconvenient. All those design flaws may be killing us.”

It wasn’t that long ago — see those classic black-and-white movies — when hospitals commonly cared for many different kinds of patients in large open wards. Young volunteers, women known as “candy stripers,” could be seen rolling carts down the aisles between the many rows of beds, selling cigarettes. Families might pop in for a visit, carrying for their sick kin a chicken dinner on a plate covered by a white napkin.

With the huge changes that the Affordable Care Act has brought to hospitals and American health care, and with the shifts that are yet to come if Obamacare gets repealed and replaced, it’s easy to forget how significantly and rapidly medical services continue to transform.

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.

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.

knee-replacement-300x240Uncle Sam is struggling to figure how best to ensure the safety, quality, and accessibility of a major surgery for a sharply rising number of seniors who need it and want the government, through Medicare, to pay for it. Baby boomers, after decades of running, dancing, aerobics, football, basketball, zoomba, and all manner of joint-stressing activity, are lining up for knee replacements. Where should these procedures occur and how should they be paid for and evaluated?

The New York Times has reported that surgeons, some in hospitals and some in free-standing surgical centers, are riven by proposed rule changes that would allow patients 65 and older with Medicare to undergo complex, extensive knee replacement operations on an outpatient basis.

The surgeons who now do these operations in hospitals say this is a risky move for patients, who now typically spend several days hospitalized in recovery. The “hospital” docs say knee replacement is a complex procedure, with high risk of infection and post-operative complications, because, for example, patients receive powerful clot-busting drugs and potent painkillers as part of the surgical regimen.

ratingsPatients need much more information in more user-friendly fashion to determine how hospitals might work best for them, a big new study finds, while also debunking a notion that’s a little hard to fathom on its face. Ordinary consumers seem clearly to understand that hospitals differ greatly in their quality, right? But this research doesn’t make the consumers’ job any easier.

The experts involved in the latest hospital research scrutinized 22 million admissions, with data from both the federal Medicare program and private insurers. They analyzed the information based on two dozen measures of medical outcomes. They took into account how sick the patients were and other factors, like age and income.

The New York Times reported on the researchers’ findings:

Because the holidays should be filled with abundant joy, here are a few ways to safeguard the health and well-being of you and yours in the days ahead:

house fireDon’t ignore deadly fire dangers

The tragic Oakland, Calif., warehouse-concert hall blaze that claimed at least 36 lives has provided a timely reminder: Fires remain a huge concern, and, especially as cold weather sets in and families add seasonal lighting displays, caution needs to be a watchword. Yes, building codes have improved admirably over time, and fire fighters and many inspectors do a public service that deserves a salute. But affordable housing, especially in big cities like Washington, D.C., remains in crisis shortage. This has forced many, including young people, into overcrowded, substandard housing—some as little more than squatters in dangerous, vacant, or dubious buildings. Meantime, many homeowners resort to space heaters or other devices (including turning on kitchen stoves and ovens) as temperatures fall. Or they’re putting up flashy holiday light displays or even Christmas trees with risky electricals. These excesses can overwhelm safety systems, and not every property owner does due diligence to maintain now common household alarms.  The National Fire Protection Association reports that firefighters across the country in 2015 responded to more than 1.3 million blazes, which killed more than 3,200 Americans and injured almost 16,000, and caused more than $14 billion in damages.  U.S. fire departments, between 2010 and 2014, responded to an estimated average of 210 home fires per year that began with Christmas trees. These blazes caused an annual average of six civilian deaths, 16 civilian injuries, and $16.2 million in direct property damage. Common sense doesn’t change: Be careful while cooking holiday feasts. Think super safety when setting up holiday displays. Reconsider if portable heaters make sense in your home. Ensure your smoke and carbon monoxide alarms are working. Click here for some seasonal fire safety ideas.

cancer immunoThe news media enthusiasm for novel treatments, especially for cancer, has been on full display: Stat, the online health news site, has just written about one patient, a noted ophthalmologist, and how he had a favorable outcome with a lingering hospital acquired infection—not due to antibiotics but after  treatment with viruses a researcher found in a nearby pond. Multiple news organizations, meantime, have reported extensively on one woman with advanced colon cancer and how she benefited from her unique genetics and cultivation of her tumor-fighting cells to experience, for now, a recovery of rare extent. The New York Times devoted thousands of words in a multi-part series about the rise of immunotherapy, medical care in which the body’s own disease-fighting capacities (see illustration of T-cell attacking a cancer cell, right) are mobilized and which Washington Post has called the “hottest field in cancer treatments.

This isn’t a knock at any one reporter or news organization. It’s vital for the media to keep audiences advised about work on the frontiers of science and medicine. Gee-whiz stories can play a key function in capturing fickle public attention and keeping it focused on a critical concern like health care, a sector that comprises 17.5 percent of the U.S. GDP. But caution and skepticism may be in real order about therapeutic innovations, especially in cancer. As the health news watchdog organization Healthnewsreview.org points out, “too many [news] stories ignore or under-report the harms of cancer immunotherapies.” The New York Times deserves some credit for balancing its hefty reporting on this issue with a detailed report on unexpected outcomes, particularly harms, from this approach:

These so-called immunotherapy drugs have been hailed as a breakthrough in cancer treatment, attracting billions of research dollars and offering new hope to patients out of options. But as their use grows, doctors are finding that they pose serious risks that stem from the very thing that makes them effective. An unleashed immune system can attack healthy, vital organs: notably the bowel, the liver and the lungs, but also the kidneys, the adrenal and pituitary glands, the pancreas and, in rare cases, the heart.

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