Articles Posted in Clinical guidelines

cancertest-294x300
Breast cancer patients may get a welcome respite from one of the disease’s dreaded aspects — its aggressive and costly treatments. New research suggests that thousands of women with early-stage breast cancer who now are told to get chemotherapy don’t need it, while a larger, significant number of patients can benefit by halving the time they’re told to take an expensive drug with harsh side-effects, especially for the heart.

Although this information should be taken in a positive light, patients should consult with their doctors about appropriate treatment for their individual case.

The prospective shifts in breast cancer treatment, based on new findings, may add to rumblings and criticisms about over-treatment and whether doctors have taken too lightly the toll — physically, mentally, and financially — that this and other forms of cancer inflict on patients.

salty-200x300If you’ve got a shaker of salt, you may want to empty it on recent news coverage of the American Cancer Society’s announcement about its new guidelines on the age to start colorectal screening. That’s because the organization’s advisory and more than a few health journalists show a shaky grasp of basic disease statistical math.

Cancer specialists, correctly, are concerned because they say they are seeing the disease in younger people, with more colon and rectum cancers detected in patients in their 20s and even in their teens. They’re unsure what’s causing this. But just how many diagnosed cases have there been — and do the numbers mean there’s enough hard science to support a new recommendation that patients get colorectal screening five years earlier than they do now, at age 45 instead of 50?

As Kevin Lomangino, managing editor of Healthnewsreview.org, a health news watchdog site, points out, too many reporters became too accepting of experts’ fuzzy math when describing a screening change that could result in patient harms. The society, and specialists contacted by many reporters, spoke often of “doubled risks,” or impressive seeming percentage increases in colorectal cancer diagnoses — but without providing actual numbers of cases.

olympus-logo-300x64Undeterred by disclosures about the disastrous results of their growing use of dirty medical scopes, doctors, hospitals, and manufacturers have failed to figure how better to sanitize many of the devices. They, instead, may be taking short cuts that ensure the devices stay unsanitary when used in invasive procedures.

Chad Terhune, a reporter now with the independent Kaiser Health News service, deserves credit for staying with the story that he first started to break several years ago at the Los Angeles Times. He reported that tainted medical scopes, used for gastrointestinal exams and made by Olympus Corp. of Japan, were tied to at least 35 deaths since 2013,and had sickened dozens of other patients.

Medical safety experts revisited a key question raised by Terhune’s reporting and investigations by staffers with a U.S. Senate subcommittee: Can medical scopes, with their many and complex components, effectively be sanitized and what must be done?

roulette-300x188Although Americans may love to wager on ponies, lotteries, and even church bingo games, they’re getting restive and confused about playing the odds with their health — and doctors need to step up their game a lot to help patients better cope with medical uncertainties.

Dhruv Khullar, a physician at NewYork-Presbyterian Hospital and a researcher at the Weill Cornell Department of Healthcare Policy and Research, has written an excellent piece for the New York Times’ evidence-driven “Upshot” column, detailing a modern, thorny part of doctor-patient relationships:

Medicine’s decades-long march toward patient autonomy means patients are often now asked to make the hard decisions — to weigh trade-offs, to grapple with how their values suggest one path over another. This is particularly true when medical science doesn’t offer a clear answer: Doctors encourage patients to decide where evidence is weak, while making strong recommendations when evidence is robust. But should we be doing the opposite? Research suggests that physicians’ recommendations powerfully influence how patients weigh their choices, and that while almost all patients want to know their options, most want their doctor to make the final decision. The greater the uncertainty, the more support they want — but the less likely they are to receive it.

antidepressant-300x225Even as the nation enters an even scarier phase in its battle against the raging opioid abuse epidemic, new and sterner warnings are flying about antidepressants. The costs of these powerful drugs add up, as does the toll of depression and its care. Users say antidepressants are a nightmare to get off of. And medical experts cast growing doubt about whether their benefits outweigh their risks.

The New York Times deserves credit for detailing the worrisome plight of an estimated 15.5 million Americans who have been taking antidepressants — sold as brand drugs like Zoloft, Effexor, Paxil, Prozac, and Cymbalta — for at least five years. The rate of the psychiatric medications’ use “has almost doubled since 2010, and more than tripled since 2000,” the newspaper reported, adding that “nearly 25 million adults … have been on antidepressants for at least two years, a 60 percent increase since 2010.”

Users who try to wean themselves from the drugs find themselves, fast, in nasty situations with “dizziness, nausea, headache and paresthesia — electric-shock sensations in the brain that many people call brain zaps,” patients told the New York Times.

superbugs-300x118Hospitals may be providing us all with too many causes for high anxiety, with reports on increasing findings of “nightmare” bacteria stalking more health care facilities than had been known, more disclosures about how taxpayers may foot an even bigger bill to deal with a beleaguered public hospital in Washington, D.C.,  and a respected reform advocate’s detailing of just how traumatizing many hospital stays may be.

Let’s start with the new research by the federal Centers for Disease Control and Prevention, a study that tried to determine just how many cases there might already be of patients infected in hospitals, nursing homes, and other medical care facilities with so-called Superbugs, bacteria that resist treatment not only with most standard antibiotics but also drugs that are deemed therapies of last resort. These include three types of bacterial infections deemed especially urgent but difficult to control: Clostridium difficile (C. difficile), aka C-diff; carbapenem-resistant Enterobacteriaceae (CREs, as shown above); and Neisseria gonorrhoeae.

CDC officials weren’t sure how many of the Superbug cases — which leave doctors and hospitals little option but to provide only supportive care — they might detect by scrutinizing records from pathology labs nationwide.

coveredcalif-300x169Although Republicans have ripped at the health insurance offered under the Affordable Care Act, a less known but also important aspect of Obamacare may soon benefit Californians. This West Coast ACA-related move also may be worth watching by patients and medical safety advocates, as well as employers and insurers.

The Golden State, the San Francisco public radio station KQED reported, soon will tell hospitals that “time’s up” for them to improve their care, and, if they fail to hit new quality and safety targets that will be part of an impending three-year contract with Covered California, the ACA marketplace operator, they will get the boot from Obamacare coverage.

Because bluer-than-blue Democratic California has gone all-in in supporting and putting ACA coverages in place, the state’s Obamacare exchange is big (more than 1 million customers and 11 approved companies) and lucrative — so much so hospitals and insurers can’t ignore the quality demands. They’re neither extreme nor should they be surprising, because state officials emphasize they have consulted with key parties for several years now in the “Smart Care California” collaborative about the plans they intend to put in place.

Seroquel-25mg-300x195In a display of just how corruptive big money has gotten to be in modern medicine, Big Pharma keeps getting dubious doctors to write so-called off-label prescriptions for powerful anti-psychotic medications — no matter their proven harm to patients nor big settlements drug makers have been forced to pay.

The Washington Post deserves credit for its investigative dissection of AstraZeneca and its “blockbuster” product, Seroquel (generic name quetiapine). It’s a medication developed to treat severe cases of schizophrenia.

Instead, as has occurred with several other drugs of its kind, doctors — in response to major marketing and sales campaigns by AstraZeneca — have decided this wallop-packing drug can be given for uses for which there is less or little evidence. The Washington Post says doctors write abundant Seroquel scripts for patients with an “expansive array of ills, including insomnia, post-traumatic stress disorder and agitation in patients with dementia.”

FAST-infographic-2016-300x169It’s no April Fool joke: Emergency doctors across the country, according to the New York Times, have been defying widely accepted standards of care and withholding a drug that rigorous clinical trials and medical specialists long have recommended for stroke victims.

Administration of the drug, tPA or tissue plasminogen activator, helps to prevent brain injury after a stroke by dissolving the blood clot and opening up the blocked vessel. Neurologists and neurosurgeons as well as cardiologists, have campaigned for its aggressive use within hours after the onset of symptoms.  Indeed, hospitals nationwide have adopted speedy stroke care, including with tPA, under slogans like “Time is Brain.”

The drug’s fast use has become so accepted, the capacity to administer it is a keystone for hospitals to receive a much-sought designation as specialized stroke treatment centers. And though it has long been thought that tPA needed to be given within three or four hours from the start of stroke symptoms, new research funded by the National Institute of Neurological Disorders and Stroke has opened the strong possibility that many more patients could benefit from tPA and neurosurgery within 16 or even 24 hours after suffering a stroke.

smoke-300x148States may be rushing to legalize marijuana, but common sense, good research, and the law may be lagging. New reports confirm what should be inarguable: Marijuana may have health harms when smoked, and it poses safety risks when used while driving.

With the new and considerable attention paid to cigarette smoking, it’s plain to see that, like tobacco, a key health worry with marijuana rests in its burning and inhalation.

It hasn’t been easy to study due to grass’ legal classifications and, therefore, the restrictions imposed on researchers. But medical scientists at the University of California San Francisco have started to find that dope smoke, direct and second-hand, demonstrates similar or even slightly greater detrimental health effects than tobacco smoke.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
Washingtonian Top Lawyer 2011
Avvo Rating 10.0 Superb Top Attorney Best Lawyers Firm
Contact Information