Accessibility of Healthcare

January 24, 2019

Savvy Rx from a resident: Docs, know why and what you’re ordering, please

Well, just because.

That isn’t a great answer for cranky toddlers with too many questions. It’s also an unacceptable but real reason why too many hospitalized patients get woken up in the middle of the night and subjected 24/7 to expensive, invasive, and often unnecessary tests and procedures.

Abraar Karan (right), an internal medicine resident at the Brigham and Women’s Hospital/ Harvard Medical School, has blogged with welcome candor about doctors’ casual acceptance of medical routines that not only discomfit but also can harm patients. As he wrote online for BMJ (aka the British Medical Journal): “The reality of medicine is that there are many things we as doctors do for absolutely no reason. That is to say, there is no evidence (randomized controlled trial or otherwise) for doing them, other than ‘that’s the way we’ve always done it.’”

January 22, 2019

Diabetes is serious. So why aren’t patients getting more treatment help?

by Patrick A. Malone

Doctors, hospitals, health officials, and disease advocacy groups race to warn about diabetes’ risks, harms, and increasing prevalence. But why, then, doesn’t modern medicine also do much more to help diabetics with the skyrocketing costs of their care, whether with insulin at excessive prices or with expensive medical aids?

Ted Alcorn of the New York Times drilled down on one slice of diabetes care to capture how medical profiteering distorts what ought to be a more direct, simple, and less pricey treatment for a disease that afflicts as many as 100 million Americans in varying degree.

He reported on the “strange marketplace” for the chemical-imbued plastic strips diabetics use to test their blood sugar, inserting them into specialized meters for glucose readings. Before diabetics adjust their diet or take insulin, they may test themselves with strips and meters as many as 10 times a day. The costs add up. Diabetics can pay thousands of dollars annually to get test strips over the counter.

January 21, 2019

Rich family played big role in opioid crisis, court records show

by Patrick A. Malone

A plutocratic clan that has labored to portray itself as enlightened patrons of the arts, science, and medicine, instead has been depicted in new court documents as drug profiteers, eager to exploit the misery and even deaths of tens of thousands of Americans.

The stories in the New York Times, Wall Street Journal, Washington Post, and at the online medical science news site Stat paint a damning picture of the Sackler family and their avarice with the family-owned Big Pharma firm Purdue. The company made the clan billions of dollars but also has become the focus of news stories, official investigations, and now a barrage of lawsuits, all asserting that Purdue played a crucial role in fomenting the nation’s opioid drug crisis.

The Sacklers had sought to distance themselves from the horrors unleashed by powerful opioid painkillers, including their company’s top-selling drug OxyContin. The opioid crisis last year alone claimed 70,000 lives, and the prescription and illicit painkillers of their ilk have become a leading cause of death for Americans younger than 50. Overdoses now savage white men, especially in ex-urban and rural areas; women 30 and older; blacks in big cities; and even children.

January 16, 2019

Obesity and poverty may stall 25-year decline in cancer deaths, experts warn

by Patrick A. Malone

Cancer hasn’t gotten knocked out of its spot as Americans’ No. 2 killer, but health officials have delivered some good news about the disease that once was considered irreversible in its lethal course: Cancer deaths rates have fallen now for a quarter of a century.

The American Cancer Society, pointing to 1991 as a peak year, says that death rates from the disease declined by 27 percent, “meaning more than 2.6 million deaths [were] avoided between 1991 and 2016.”

Still, 1.7 million Americans likely will be diagnosed with cancer this year, and the disease will kill more than 600,000 patients — meaning 1,666 people per day in this country will die of cancer.

January 15, 2019

Overdose deaths soar among women 30+

by Patrick A. Malone

A new kind of gender equality can only be seen as tragic and sad: Drug overdoses are soaring among women older than 30, with a giant spike in these deaths due to opioids.

The federal Centers for Disease Control and Prevention (CDC) reported that since 1999, drug overdose death rates “increased by approximately 200 percent among women aged 35–39 and 45–49 years, 350 percent among those aged 30–34 and 50–54 years, and nearly 500 percent among those aged 55–64 years.” Overall for women aged 30-64, the CDC says, the rate of opioid overdose fatalities increased by a whopping 492 percent from 1999 to 2017.

The new data show the malignancy of the opioid crisis, which claimed more than 70,000 American lives in just the last year — more men than women. The overdose death rate itself rose in one year alone by 10 percent, and federal authorities say such incidents, intentional or accidental and too often now involving the powerful synthetic opioid fentanyl, have become a leading killer of Americans 50 and younger.

January 11, 2019

Add these to your 2019 health resolutions: Hearing, diet, and clutter

by Patrick A. Malone

We’re still early enough in 2019 that if you felt you didn’t resolve in enough excellent ways to improve your health and well-being, there are a few more solid strategies to check out.

You could, for example:

Get your hearing checked and ensure you’re protecting and enhancing it in every appropriate way.

January 9, 2019

Hospitals post price lists, but patients still cannot decipher what care really costs

by Patrick A. Malone

Ever noticed how tourists strolling our cities’ streets not only pause and peer into the windows of restaurants but they also invariably make a beeline for the menu posted out front? That’s smart consumerism, right, and so common sense that, hey, why doesn’t such price-checking work in medical care, too?

Well, think again: The nation’s in the midst of yet another experiment to try to make clearer and more transparent the soaring prices of medicine. With the dawn of 2019, Uncle Sam decided that hospitals needed to make available online their “chargemasters,” the giant list of their supposed prices for facilities, services, and prescription drugs.

Good luck, though, to consumers to find this important document, as required now by law, on hospital websites. Good luck, too, for patients in determining just what the sizable Excel spreadsheets mean for their finances and budgets.

January 6, 2019

A clarion call for real safeguards for patients harmed by medical devices

by Patrick A. Malone

Medical devices race onto the market with little or no effective testing or regulatory safeguards, and a proposed “reform” of the oversight system of products that are implanted in tens of millions of Americans is a sham, safety advocates say.

That’s because there are gaping flaws in the proposal to alter the so-called 510(k) procedure under which the federal Food and Drug Administration clears medical devices for sale, say medical journalist Jeanne Lenzer (right) and health care activist Shannon Brownlee (left).

Their Op-Ed in the Washington Post is the latest salvo against FDA Commissioner Scott Gottlieb’s claims of “transformative” changes in medical device regulation by his agency. News organizations around the world in recent weeks have published investigations of how poorly such products are tested, reviewed, and then released on markets, killing and injuring patients as a result.

January 4, 2019

Who didn’t see this coming? Patient anger grows over knee surgery hype

by Patrick A. Malone

With a graying nation projected to see millions of patients undergoing knee replacements each year at an annual cost to taxpayers running in the billions of dollars, it may be past time to ask if surgeons and hospitals promote and perform these popular procedures to excess.

Liz Szabo, in a story written for the nonprofit, nonpartisan Kaiser Health News Service (KHN) and published in the Washington Post, reported that knee surgeries have their “risks and limitations,” and “doctors are increasingly concerned that the procedure is overused and that its benefits have been oversold.”

As she wrote:

January 2, 2019

Patients put at risk by lax oversight at psych hospitals and surgery centers

by Patrick A. Malone

As the new year gets under way, regulators and lawmakers need to look hard at a nightmare in New Jersey involving a free-standing surgical center and to a nationwide harms occurring in psychiatric hospitals to ensure that these and other institutions improve the safety and quality of their patient care.

USA Today and the Wall Street Journal, in separate stories, reported about shoddy practices and lax oversight that contributed to significant problems in the medical facilities.

The Journal investigated hospitals for the mentally ill and found that, “More than 100 psychiatric hospitals have remained fully accredited by a major hospital watchdog despite serious safety violations that include lapses linked to the death, abuse or sexual assault of patients.”