Communication

April 19, 2019

Concern grows over seniors taking their own lives in long-term care facilities

With 3 out of 4 Americans insisting they would prefer to age in place at home, senior care institutions already face stiff headwinds. But an investigation by two media organizations paints a glum picture of a little discussed aspect of elder life: the “lethal planning” some older residents make in nursing homes, assisted living centers, and adult care facilities — to end their own lives.

The exact suicide toll among the 2.2 million elderly Americans who live in long-term care settings is poorly tracked and difficult to quantify, reported the independent, nonpartisan Kaiser Health News (KHN) service and PBS NewsHour (see the broadcast report by clicking here). But the two news organizations found:

[An] analysis of new data from the University of Michigan suggests that hundreds of suicides by older adults each year — nearly one per day — are related to long-term care. Thousands more people may be at risk in those settings, where up to a third of residents report suicidal thoughts, research shows. Each suicide results from a unique blend of factors, of course. But the fact that frail older Americans are managing to kill themselves in what are supposed to be safe, supervised havens raises questions about whether these facilities pay enough attention to risk factors like mental health, physical decline and disconnectedness — and events such as losing a spouse or leaving one’s home. More controversial is whether older adults in those settings should be able to take their lives through what some fiercely defend as ‘rational suicide.’

April 16, 2019

Telemarketing “free” back and limb braces for seniors adds up to a $1.2 billion Medicare fraud

by Patrick A. Malone

Federal authorities have busted up what they say is a $1.2 billion Medicare fraud that should give taxpayers and patients pause about long-distance medical consultations and the huge sums of cash washing around the medical device industry.

Two dozen people, some of them doctors, have been charged in a complex ploy to gull seniors into asking about back, shoulder, wrist, and knee braces that were promoted as free on TV and radio ads nationwide. When the older adults called to inquire about the devices, they were transferred to telemarketing centers in the Philippines and Latin America.

In the far-away boiler rooms, trained operators extracted important personal information from callers, then connected them for “telemedicine” consultations with cooperating doctors. The MDs asked cursory questions before then prescribing the devices, whether needed or not. The orders were filled by select companies, which then would send out the braces and charge them to Medicare.

April 15, 2019

When hospitals battle superbug outbreaks, shouldn’t patients be informed?

by Patrick A. Malone

When big hospitals are locked in bare-knuckle battles against debilitating and deadly bacterial and fungal infections sweeping their institutions, don’t patients have the right to know about these situations that might affect their lives and care? According to some hospital insiders, no.

The New York Times reported that a “culture of secrecy” prevails in hospitals as they combat “super bugs,” bacteria that have become resistant to antibiotics and now fungi that have evolved immunities to antifungals.

The newspaper found the institutional opposition to making public outbreaks of hospital-borne infection as it followed up its own scary page one story about the global spread of Candida auris, a drug-resistant fungus that preys on patients who already are hospitalized and may have compromised immune systems.

April 12, 2019

Wheel-dropping strollers and cars ablaze: Watchdog agencies retreat from protecting the public

by Patrick A. Malone

It may sound catchy when politicians claim to want to get Uncle Sam out of our wallets and off our backs. But the deregulatory reality may look different when hundreds of thousands of baby strollers have front wheels that suddenly fall off, or millions of family cars may be at risk of bursting into flames.

The Washington Post has dug deep into how a case involving the BOB, a British-made, three-wheeled stroller, illustrates how the Consumer Product Safety Commission (CPSC) has become more industry friendly and turned away from vigorous protections for ordinary Americans.

The political party in power, aka the Republicans, not only get to fill commission openings, they also take over the important chair of the panel. That leader sets the tone and often pushes fellow party members on the commission to hew to it. The GOP has controlled the commission for the first time in a decade, and Republican chair Ann Marie Buerkle is making herself felt in agency actions.

April 11, 2019

FDA battles sketchy stem cell claims, while big hospitals jump into unproven treatments too

by Patrick A. Malone

When doctors and regulators crack down on the burgeoning and risky use of purported stem cell therapies, some well-known and respected big hospitals and health systems may have their own practices to explain, too.

As Liz Szabo reported for the nonpartisan Kaiser Health News Service:

Swedish Medical Center, the largest nonprofit health provider in the Seattle area … is one of a growing number of respected hospitals and health systems—including the Mayo Clinic, the Cleveland Clinic and the University of Miami—that have entered the lucrative business of stem cells and related therapies. Typical treatments involve injecting patients’ joints with their own fat or bone marrow cells, or with extracts of platelets, the cell fragments known for their role in clotting blood. Many patients seek out regenerative medicine to stave off surgery, even though the evidence supporting these experimental therapies is thin at best …

April 9, 2019

Concern rises about vaccination exemptions, as infectious diseases spread

by Patrick A. Malone

As outbreaks of preventable infectious diseases rise to concerning levels, doctors, regulators, and lawmakers may need to toughen important laws requiring youngsters to be inoculated, protecting better our collective health and closing off legal loopholes for sketchy vaccination exemptions.

It would be ideal if more than a century of lifesaving experience and decades of rigorous scientific research were sufficient to persuade parents to get their children vaccinated against an array of harmful and dangerous infections. But grownups’ hesitancy or rejection of shots, out of unfounded personal belief or due to medical disinformation, has set in and spread. This has undercut local, national, and global campaigns to rid humanity of contagions like measles. Public information campaigns and evidence-based persuasion hasn’t worked as well as experts might hope, leading officials to pass vaccination laws.

But those protective measures have been eroded by the exploitation by a few, so far, of well-intentioned exemptions, reporters for the independent, nonpartisan Kaiser Health News reported.

April 8, 2019

With costly medical over-testing, causes can be blurry, solutions complex

by Patrick A. Malone

Although experts estimate medical over-testing adds more than $200 billion in wasted spending in the U.S. health care system, reducing it can be hard, as we can see from one example in eye surgery.

Let’s zoom in on cataract surgery, a procedure in which eye surgeons (ophthalmologists) aim to relieve the visual clouding that many patients experience as they age, taking out the natural lens and putting in an artificial replacement. The surgery isn’t without risks, but it goes swiftly and with minor inconvenience for most patients, who get to go home the same day.

For healthy seniors undergoing cataract surgery, the professional consensus has seemed clear for not quite two decades: preoperative testing—which may include a complete blood count, chemical analysis, coagulation studies, urinalysis, electrocardiography, echocardiography, cardiac stress tests, chest radiography, and pulmonary-function tests—is unnecessary. This has been established by rigorous studies (see here and here), as well as by the stringent Cochrane review. The American Academy of Ophthalmology has made this a guideline or clinical statement and spread the word, notably through the public Choosing Wisely initiative that counsels patients on key procedures they need to ask their caregivers about if they’re ordered.

April 7, 2019

Politicians disconnect from good sense, even as U.S. health care worries soar

by Patrick A. Malone

When it comes to something as crucial as health care, let’s keep it simple: Americans deserve better than this …

Can President Trump keep up his barrage of counter-factual assertions and political reverses on federal help for those needing health insurance, a key part of the Affordable Care Act? After resurrecting in federal courts the decade-long debacle of Republican efforts to kill Obamacare—including its protections for preexisting conditions—Trump flipped yet again. He heard an earful from party leaders that they have no way to cover tens of millions who would lose their health insurance if the ACA gets tossed out by courts, and he apparently awoke to the reality that the GOP can’t eliminate the law when Democrats control the House. So, the president then insisted that the GOP, after failing to do so for years, would present a better alternative and enact it, repealing Obamacare, too—at some time after the 2020 elections. If Republicans win back the House, keep control of the Senate, and he is reelected.
Even as the president asserted the GOP’s superiority in health care policy, the Los Angeles Times and the Philadelphia Inquire reported that a key element of Trumpcare is bringing back consumer nightmares. Patients initially might like the short-term health insurance plans the administration has pushed as an ACA alternative. Officials have relaxed rules on them so they can last longer than the few months permitted under Obamacare. The plans may carry lower monthly premiums. But they come with skimpy benefits. Which consumers are rediscovering. They’re getting sick and hoping to rely on short-term policies, only to find they owe doctors and hospitals thousands of dollars—but their insurance won’t help them with a penny.

April 4, 2019

As GOP keeps slashing at health coverage, big strains of caregiving ignored

by Patrick A. Malone

Americans have real reason to fear a health care catastrophe: If loved ones suffer major injury or illness, who will feed, bathe, and care for them 24/7 after they get out of the hospital and recuperate at home? Who will take time off from work to set up and take them to unending and long medical appointments? Who will wait for and get all the pills and devices they need?

The nation has been locked in a decade-long battle over health insurance that helps cover medical costs, but caregiving, a crucial part of the social safety net, gets short shrift, writes Aaron E. Carroll, a professor of pediatrics and health research and policy expert at Indiana University School of Medicine. As Carroll noted in a timely and personal column for the New York Times “Upshot” feature:

Americans spend so much time debating so many aspects of health care, including insurance and access. Almost none of that covers the actual impossibility and hardship faced by the many millions of friends and family members who are caregivers. It’s hugely disrupting and expensive. There’s no system for it. It’s a gaping hole.

April 3, 2019

$1 billion+ may seem like a lot of money. It still can’t resolve many questions.

by Patrick A. Malone

Although lawsuits can result in needed financial support and welcome recognition of harms suffered by patients seeking medical services, the civil justice system has its limits. They showed in cases in the news in which disputing parties agreed to more than $1 billion in resolutions that left issues unanswered.

What to make of the:

$270-million that Purdue Pharmaceutical will pay to end its part of a fight with Oklahoma over the opioids crisis that has killed hundreds of thousands of Americans