Accessibility of Healthcare

March 6, 2020

Routine cognitive tests for seniors? Not for now, blue-ribbon panel advises

It sounds like a good idea. Have primary care doctors learn about older patients’ cognitive health by putting all of them, during routine office check-ups, through a few minutes of tests in which they are asked to recall lists of words, draw a clock face, describe the day and date of their appointment, talk about current events, and take on other simple tasks.

Such screenings, some advocates for the aged say, can be an important way to diagnose early and try to provide for help for patients with dementia and its most common affliction, Alzheimer’s disease. But a blue-ribbon panel of experts that advises the nation on medical testing and procedures isn’t buying the argument: The U.S. Preventive Services Task Force (USPSTF) has given such screenings the group’s letter-grade rating of I, meaning the evidence is incomplete that a test or procedure is harmful or beneficial.

The panel, updating its 2014 findings, reported on the JAMA Network (the online medical journal collection) that:

March 5, 2020

At the VA, concerns increasing about top leadership and outside meddling

by Patrick A. Malone

One of the nation’s largest health systems faces yet more serious questions about its leadership and external meddling in the quality and safety of its care. So, once again taxpayers may be asking themselves, with anger, What the heck is going on now at the top of the Department of Veterans Affairs?

Internal watchdogs have formally opened an investigation of Roger Wilkie, the VA’s chief, over allegations that he used his office and authority to dig up dirt on a Democratic aide who complained that she had been propositioned and groped by a man in the main lobby of the Medical Center here in the District of Columbia.

The claims were investigated, and authorities declined to pursue it further, including with the filing of any charges.

March 3, 2020

Drug maker to pay $1.6 billion to settle claims over its big role in opioids crisis

by Patrick A. Malone

The civil justice system has scored a win in curtailing what once was a major maker of much abused and lethal prescription painkillers: Mallinckrodt, a global drug making giant, has agreed to send its opioids-making generics division into bankruptcy as part of a $1.6 billion settlement to settle thousands of opioid damage claims by state and local governments.

As the New York Times reported of the hefty deal:

“The agreement was endorsed by 47 states and U.S. territories along with a committee of lawyers representing thousands of cities and counties … The money, to be paid into a cash trust over eight years, will be used to underwrite the costs of opioid addiction treatments and related efforts across the country … Under the terms of the agreement, the United States division of Mallinckrodt that produces generic opioids would file for Chapter 11 bankruptcy. After a bankruptcy judge approves the restructuring plan, an initial payment of $300 million would be disbursed to plaintiffs to alleviate the opioid crisis, with the remaining $1.3 billion to be paid out over eight years. Other divisions of the company, which has its headquarters abroad and also produces branded drugs, are not filing for bankruptcy. Mallinckrodt is the first opioid company to reach even a tentative national settlement agreement with municipal governments and most of the states.”

February 28, 2020

For seniors, harsh realities about dying at home, dementia drugs, and job harms

by Patrick A. Malone

Although Americans may have particular wishes as to how their lives might close out, they aren’t getting these optimal outcomes for themselves and their loved ones.

Instead, the much-desired option of dying at home is proving to be stressful and draining to the extreme for families, and, when it comes to the dreaded loss of control involved with Alzheimer’s disease and dementia, drug therapies seem elusive in a concerning and crushing way.

Older workers’ health is becoming a startling concern, too, for many more employers as seniors stay on the job longer than they have before — leading to more workplace injuries and deaths.

February 21, 2020

Will voters buy $1 trillion in U.S. health care cuts, as ’21 budget proposes?

by Patrick A. Malone

President Trump’s 2021 budget proposal is thicker than an old-fashioned phone book. Lots of the document became little more than chaff the instant it was printed, due to the likelihood of big changes in the spending plan by congressional Democrats and lawmakers of the president’s own party.

The fiscal wish list, unsurprising at its contents were, may raise a big political question: How, with evidence like this, does the leader of the free world campaign on a counter-factual argument that his policies and practices protect and advance the health of the American people — a prime concern, pollsters say, of the voting public?

The $4.8 trillion Trump budget, for example, proposes to slash the Medicaid and food stamp programs by $1 trillion over a decade, with presidential critics noting the various, sometimes bureaucratic means to do so, ultimately, will reduce desperately needed social supports and throw millions of vulnerable Americans off aids for their health care. (Federal courts, including the appellate panel overseeing Arkansas, have rejected the latest way the administration and GOP states have sought to reduce Medicaid costs by imposing draconian work, reporting, and qualifying rules.)

February 19, 2020

When organs get shipped as cargo, delays and losses become disastrous

by Patrick A. Malone

For tens of thousands of patients anxiously awaiting lifesaving transplants, a new media investigation has provided what must be heart-breaking news on the laxity with which dozens of donated organs get transported, causing them to be lost or delayed “cargo” and rendered unusable.

The nonprofit, independent Kaiser Health News Service and the Center for Investigative Reporting deserve kudos for following up on the jaw-dropping story of how a human heart got left behind in 2018 on a Southwest Airlines flight. Medical specialists involved at the time downplayed the incident, noting that surgeons had not planned a direct transplantation of that heart in a patient in dire shape, taking various of its valves and tissues, instead.

Still, when reporter JoNel Allecia dug into the ghastly gaffe, she found an organ transplant nightmare. As Allecia described it:

February 16, 2020

Battle may be in new phase against the virus now named Covid19

by Patrick A. Malone

The spreading virus that has sickened tens of thousands and killed thousands — mostly in central China in Hubei province and its big capital city, Wuhan — now has a name: Covid19.

Public health officials hope that this moniker, along with new images of the virus, will make talking about this disease easier and reduce the exploding stigma that’s attaching to it, with mis- and dis-information fueling unwelcome panic, racism, and xenophobia.

The disease continues to batter China, with the cases in two dozen or so other countries limited to a few hundred and deaths in the single digits. The Chinese remain in a sweeping lockdown or quarantine that has brought much of the most populous nation in the world to a standstill since at least the start of the lunar new year, a major travel holiday across Asia. Officials now also are conducting dragnets and round-ups of those potentially ill.

February 13, 2020

A top U.S. health official can’t get his. Which is why we need records reforms.

by Patrick A. Malone

Federal regulators may be on the brink of not only protecting but also advancing patients access and use of a key component of their care: their electronic health records. Or will bureaucrats fold up in the face of a muscle campaign by corporate interests and hospitals?

To its credit, the giant Health and Human Services agency has emphasized that it is moving forward in its announced plans to prepare new regulations on so-called EHRs, pressing patients’ rights and newer, and potentially more nimble tech firms’ abilities to make the information in the records more accessible and helpful.

But Epic, the giant software company that has installed electronic systems in hospitals and health systems nationwide — often for billions of dollars — is leading resistance to the new rules. It has convinced dozens of institutions and groups, some sizable, to lobby officials to oppose this federal intervention.

February 11, 2020

Crucial doctor-patient relationships showing distressing signs of fraying

by Patrick A. Malone

Although health policy experts and doctors themselves may sing the praises of primary care providers — medical generalists who are supposed to be the first and important caregivers for most patients — recent studies suggest that yet another idealized aspect of the U.S. health care system has cost- and access-driven problems.

Patients, to start with, are driving a concerning trend in which they in increasing numbers are declining to tap the services of family doctors and other so-called PCPs.

Doctors in this field, as well as others, say that patients may be turning to online consultations, urgent care centers in drug stores and shopping malls, or more costly visits to highly credentialed specialists due to the spiking pressure on frontline MDs to maximize revenues by minimizing their “face time.” Physicians describe how “bean counting” executives in health systems may require them to see more than a dozen patients a day, while also handling all the bureaucracy, consultation, research this requires — or face sizable pay cuts for their “inefficiency.”

February 9, 2020

As coronavirus pummels China, concern rises about U.S. health care supplies

by Patrick A. Malone

The toll of the coronavirus outbreak in China keeps worsening, with the infections exceeding tens of thousands and the deaths spiking toward 1,000, also claiming the first American and Japanese lives of people in the disease epicenter of Wuhan.

The illness’ most significant harms continue to afflict China, particularly its central province of Hubei and regional capital Wuhan.

But the infection has raised global alarms, in part because its death toll, for example, has far exceeded in China the fatalities recorded with the 2003 disease incident involving Severe Acute Respiratory Syndrome, or SARS. That infection killed hundreds in China.