docshistoric-300x234Doctors put their patients at grave risk by failing to stay current with professional best practices, eliminating outdated and ineffective therapies and approaches and instead learning and adapting better ways of care, notably treatments to help deal with the opioid crisis.

Vulnerable children can pay an unacceptable price, for example, for pediatricians’ unwillingness to “unlearn” what they were taught decades earlier in medical school, reported Aaron Carrol, a professor of pediatrics at Indiana University School of Medicine, a health researcher, and a contributor to the New York Times’ evidence-based column “The Upshot.” As he wrote:

In May, a systematic review in JAMA Pediatrics looked at the medical literature related to overuse in pediatric care published in 2016. The articles were ranked by the quality of methods; the magnitude of potential harm to patients from overuse; and the potential number of children that might be harmed. In 2016 alone, studies were published that showed that we still recommend that children consume commercial rehydration drinks (like Pedialyte), which cost more, when their drink of choice would do. We give antidepressants to children too often. We induce deliveries too early, instead of waiting for labor to kick in naturally, which is associated with developmental issues in children born that way. We get X-rays of ankles looking for injuries we almost never find. And although there’s almost no evidence that hydrolyzed formulas do anything to prevent allergic or autoimmune disease, they’re still recommended in many guidelines.

brca-cancer-risk-261x300Even as a pair of prominent researchers saw their reputations crumble over controversies connected to their work, a University of Washington team showed anew the importance of rigorous, transparent, independent, and widely shared medical science  to patients, in this case those with cancer.

Let’s start with the seemingly positive take that’s accompanying publication in the journal Nature of research regarding an open database with prospectively valuable information on BRCA1 variants, what some have dubbed the “cancer risk” gene.

Everybody carries both BRCA-1 and BRCA-2 genes, named because BR stands for breast and CA for cancer. All of us have two copies of each gene, one passed down from our mother, the other from our father. The genes make proteins that help repair errors in our DNA that pop up from time to time when our cells divide and duplicate their genetic code.  Mutations in either BRCA gene can disable the repair process and make both women and men carriers of the defect susceptible to certain kinds of cancer.

cduntsch-300x300It carries the plot line of a compelling crime story: A knife-wielding assailant works his way into exclusive institutions across a metropolis. There, time after time, he rips into  victims, inflicting great pain and suffering. He acts under the noses of people who should know better. He gets stopped only when someone in law enforcement steps beyond norms to bring him to justice. There’s even a systemic flaw that makes the drug abusing criminal’s acts more awful.

It’s painful and tragic, however, that the saga of Christopher Duntsch, aka “Dr. Death,” is all too gory, true, and potentially avoidable. It has become even more public via modern technology, an increasingly popular and free podcast by Laura Beil on the Wondery site.

Duntsch, now serving a life sentence in prison, moved from one hospital to another in Dallas, where the cancer-researcher and neurosurgeon morphed himself into a spinal surgeon. He was awful. Colleagues reported him to hospitals and medical licensing officials. They stepped in front of him in operating suites and took instruments out of his hands during surgeries. Duntsch, D magazine says, abused drugs, partied, and talked about having wild sex often before long, complex operations. There have been reports that he may intentionally have tried to maim patients. His surgeries were tied to deaths.

juulcig-300x159Has one of the nation’s top health watchdogs awoken too late, barked too little, and, maybe won’t bite enough as Big Tobacco and its allies have addicted a generation of young people to nicotine?

Scott Gottlieb, commissioner of the federal Food and Drug Administration, captured extensive media attention by hitting the alarm button about “epidemic” vaping and teens’ use of e-cigarettes, notably the wildly trendy Juul device and others of its kind.

He said the FDA has acted against 1,300 retailers for peddling e-cigarettes and their liquid flavorings to underage customers. More key: The agency has told Juul and other leading makers that they have 60 days to show how they can keep their products out of the hands of customers 18 and younger — or the FDA may ban them from the market.

cdcheadsup-300x111Common sense and moderation can matter a ton in maintaining good health, as recent news reports show, particularly with kids and concussions, middle-aged adults and heart disease, and collegiate alcohol abuse.

With youngsters returning to school and so many of them participating in sports and recreation programs, it’s good that the federal Centers for Disease Control and Prevention has issued evidence-based guidance on protecting kids who suffer mild traumatic brain injury or what most of us would call concussions.

These injuries have become a growing concern for parents and young athletes. Sports leagues and sporting groups are coming to a time of reckoning with just how harmful head trauma can be.

theater-228x300What’s an internist to do when an 81-year-old patient, already in failing health with advanced emphysema, seeks a second opinion because he’s been told his prostate specific antigen (PSA) levels are unacceptably high? This senior also has been advised to schedule a prostate biopsy urgently to determine if he has cancer. Can this discussion with both a scared patient — and his bright, concerned personal doctor — be any tougher?

For Andrew Lazris, who is also a geriatric specialist practicing in Maryland, this was a hard, complicated case because it involved his dying dad.

It also exemplified for him the work that he has undertaken with Eric Rifkin, an environmental scientist and adjunct researcher at Johns Hopkins University, in ensuring that patients retain their fundamental and critical right to have a say in their care. And, in doing so, they have developed what they argue is a clear, comprehensible way to help patients grasp and deal with the inevitable uncertainties, risks, and complexities of the array of medical treatments they can get overwhelmed with by doctors, hospitals, Big Pharma, medical device makers, and others in health care.

Bundle-300x151Federal regulators may be forced to reconsider their plans to curtail a cost-containing experiment that affects some of the most commonly performed surgeries — knee and hip replacement procedures that hundreds of thousands of seniors undergo annually through their Medicare coverage at a cost to taxpayers of billions of dollars.

Under the Affordable Care Act, doctors and hospitals were pushed to adopt a new and different way to think about and to bill for these surgeries, which, by the way, aren’t risk free. Instead of patients getting flooded with bills from each provider involved — the lab, radiologist, anesthesiologist, surgeon, hospital, and so forth — Obamacare got all the parties together and told them they would get a single, “bundled payment.” Hospitals, typically, then acted as the chief point of contact, getting the providers to figure their fair share, billing patients (once), and collecting reimbursements and distributing them appropriately.

The system seemed to work: costs declined, the quality of care went up, and patients expressed relief that their mailboxes weren’t jammed with a blizzard of the usual incomprehensible medical bills. But doctors, hospitals, and insurers kept grumbling. The Trump Administration and Republicans in Congress, as part of their relentless and counter-factual assault on the ACA (more on that in a second), took aim at bundled payments and talked about changing and eliminating this approach.

Nursing homes, by scrimping on their staffing to maximize their profits, put their residents at grave risk for infections that too often have grisly and deadly results. Low-rated facilities run by Uncle Sam to care for elderly veterans also may be concerning. And those oft-pricey assisted living facilities may have their own response to dealing with difficult to care for elders — putting them out on the street.

Kaiser Health News Service, the Chicago Tribune, USA Today, and the Boston Globe all deserve credit for their digging into problems at facilities caring for the old, focusing on issues that should be at the fore for regulators, policy-makers, and politicians as the nation grays.

cdcvape-300x200
Big Tobacco and its allies long have exploited evolving media to hawk harmful products, promoting them as desirable and sexy in print, movies, radio, television, and online. So, it’s not exactly a surprise that these merchants of death have become masters of marketing on social media, targeting young consumers worldwide.

Their latest campaigns may let cigarette- and e-cigarette-makers skirt regulations, some of them tough and aimed at protecting naïve, vulnerable kids from lifetime addictions.

The tobacco hype may be working all too well, with researchers at Johns Hopkins and elsewhere finding that 10.8 million adults in the United States are “vaping,” with 54.6 percent of e-cigarette users also smoking cigarettes. “About 15 percent of vapers had never smoked cigarettes, and 30.4 percent had quit smoking them,” the newspaper reported.

ncaalogo-300x200College football has kicked off its fall season with a flourish, but the signs are increasing that concerns about players’ health and safety may slash at the game’s size, spectacle, and importance.

Just as the pro leagues were forced to answer in court for the harms that athletes suffer due to repeated blows to their heads, the National Collegiate Athletic Association (NCAA) has been hit with claims in the civil justice system, asserting wrongful deaths of players from the recent past.

Lawsuits, believed to be part of what will be a wave, were filed against the college sports conference on behalf of the survivors and estates of a onetime University of Southern California fullback and a University of California at Los Angeles running back.

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