Patient Safety Blog

The New York Times has an interesting article about the recent decision of some scientists to refuse payments from the pharmaceutical and medical device industry. From the article:

No longer will they be paid for speaking at meetings or for sitting on advisory boards. They may still work with companies. It is important, they say, for knowledgeable scientists to help companies draw up and interpret studies. But the work will be pro bono.

The scientists say their decisions were private and made with mixed emotions. In at least one case, the choice resulted in significant financial sacrifice. While the investigators say they do not want to appear superior to their colleagues, they also express relief. At last, they say, when they offer a heartfelt and scientifically reasoned opinion, no one will silently put an asterisk next to their name.

The entire article is worth a read. If more and more scientists do this, then patients researching their conditions and curious laypeople will have one less cause for skepticism about what they're being told.

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What is Anesthesia Awareness, also known as Unintended Awareness? It is when a patient wakes up during surgery. When this happens, the patient experiences extreme pain but cannot move or cry out. The patient often also remembers parts of the surgery. This can have long-term emotional and psychological effects.

A new study shows that Anesthesia Awareness is more common than experts had previously thought. What can be done about this? From the article:

The position of the anesthesiologists group has been that brain wave monitoring should not be done routinely, but may be helpful for certain patients at high risk of awareness. Widespread use would be very costly.

Patients should talk to their doctors to determine their risk, if any, of awareness.

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Out of nineteen industrialized nations, the U.S. has the most deaths that could have been prevented by access to timely, effective medical care.

Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine performed the study, looking at deaths before the age of seventy-five caused by numerous diseases and complications. They found that France performed the best by this measure--though France, and other countries that ranked higher than the U.S., spends less money on health care than the U.S. does.

Not only was the U.S. the worst in these rankings, but we Americans are also ranked four places lower than we were in the last study (which covered 1997 and 1998). We are getting worse and spending more money.

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Posted In: General , Medical Error , Medications , Standard of Care--Hospitals , Surgery

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If you're accustomed to taking many pain-killers for your headaches, and if your headaches have been increasing in frequency and intensity, then over-medication might be the cause.

At any given time, more than three million Americans are suffering from headaches they are inflicting on themselves, according to Dr. Stephen D. Silberstein, a professor of neurology and director of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia. “If a patient’s headaches have grown markedly worse or more frequent, the problem is almost always medication overuse,” Dr. Silberstein said.

The pattern seems to be that a patient starts getting headaches, takes too many pills to cope and as a result keeps getting more headaches thanks to the side-effects of the pills.

Which head-ache medications are causing this? Those that include caffeine and butalbital. The worst offenders seem to be those that contain both, Aspirin, caffeine and butalbital is the generic common combination of drugs found in many headache treatments--Fiorinal, for example, or Floricet. But, as the doctors cited in the articles note, any pain-killer can be taken to excess. It may be difficult for headache sufferers to cut back on pain-killers but research suggests that doing so will reduce tension headaches in the long run.

Other resources on the subject of these treatments and their side-effects:

Medline: Aspirin, caffeine and butalbital

RxList: Floricet and Floricet Side-effects

Medicine.net: Side-effects of butalbital/acetaminophen/caffeine

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The President's Cancer Panel--consisting of Lance Armstrong, Dr. Margaret Kripke and Dr. LaSalle D. Leffall--says, in its new report, that the U.S. government should be doing more to promote environments and lifestyles that prevent cancer and other diseases.

Part of the report's argument is that most federal funding for cancer research goes towards genetic and microbiological solutions, and that macro-solutions involving environmental and social factors are neglected. This is part of a general problem in the philosophy of health care in the U.S., the report says: we are overly focused on treatment rather than prevention.

Of course treatments are important, but the report is right in its criticism of the neglect of the concept of a healthy lifestyle in U.S. health care. Making such lifestyles possible would require social changes as well as personal changes--which may be one reason why the government and our society finds it more convenient to focus on treatment, as treatment will not require systemic overhaul of society. It is more tempting to try and simply patch people up with treatments rather than take the time and effort to ensure that fewer people get sick in the first place.

Here are some examples of environmental and social factors that the report considers responsible for poor American health: lack of fresh food access, lack of access to healthy food in general (for those in poorer socioeconomic conditions), large subsidies to producers of corn and so which are processed into foods that contribute to various diseases, lack of opportunity to exercise and lack of health insurance.

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Posted In: Cancer , General

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A diagnosis of cancer puts a patient in an extremely frightening and vulnerable position. Unfortunately, there is often little aid for people in this situation. Instead, they are presented with bureaucratic hurdles and confusion about whose advice to follow.

For an example, one could look at the July 29th, 2007 New York Times Magazine section which had an article describing the story of one such cancer patient named Karen Pasqualetto.

There are several insights that can be gleaned from such experiences. First, there is the need for patients to seek second and third opinions—a need that usually goes unfulfilled because most people do not have the insurance or financial resources to cover this.

Second, patients need to educate themselves on standards of care, because otherwise they probably will not be getting it—particularly if they are not white or are low-income. See the National Healthcare Disparities Report from 2005 for disparities related to race and socioeconomic status. The ScienceDaily also has an article about racial bias resulting in poorer treatment for African-American patients.

Third, there are enormous advantages to having a team of doctors who speak to each other rather than a bunch of disconnected specialists who offer competing and contradictory advice. Patients should encourage communication between doctors as much as possible.

Fourth, visiting centers for the study of particular kinds of cancer can be extremely helpful, especially when dealing with the more obscure varieties of the disease. These centers have the aid and cooperation of several doctors, so the opinions given there are more likely to reflect a consensus of experts.

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Posted In: Cancer , General

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A recent Millennium Research Group analysis found that medical errors cause up to 98,000 deaths annually, making them the fifth-leading cause of death in the U.S. The findings are described in Medical News Today.

A senior analyst at MRG says that miscommunication, transcription errors and incomplete patient records are often the causes of such mistakes.

According to MRG, this has resulted in increased demands for patient safety improvements. Clearly such improvements are badly needed.

The FDA also has information on the issue of medical errors, including the factors that prevent improvement in the system. One such factor is the culture of secrecy that leads medical personnel to cover up errors rather than admit to them, even when the stakes are extremely high.

For more details, check out the 2000 Report to the President on Medical Error by the Quality Interagency Coordination Task Force.

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