Articles Posted in Conflicts of Interest

eldercare-300x168Uncle Sam soon will step up what may be a positive trend: getting hospitals and nursing homes to halt the unacceptable boomeranging of elderly patients between them. But will Trump officials be as quick with health care providers as they have been with poor, sick, and old patients to employ not just carrots but also sticks to get better outcomes?

The nonprofit, nonpartisan Kaiser Health News Service deserves credit for looking ahead to this fall, when the administration aims to accelerate the end of perverse incentives that have hospitals and nursing homes shuttling the sick and elderly between them far too often. As Jordan Rau of the news service reported:

With hospitals pushing patients out the door earlier, nursing homes are deluged with increasingly frail patients. But many homes, with their sometimes-skeletal medical staffing, often fail to handle post-hospital complications — or create new problems by not heeding or receiving accurate hospital and physician instructions. Patients, caught in the middle, may suffer. One in 5 Medicare patients sent from the hospital to a nursing home boomerang back within 30 days, often for potentially preventable conditions such as dehydration, infections and medication errors, federal records show. Such re-hospitalizations occur 27 percent more frequently than for the Medicare population at large.

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.

catheterablation-300x193It’s one thing when modern medicine becomes so hidebound that it struggles over shedding a bit of traditional doctors’ garb. But new information emerging about cardiology’s entrenched reliance on maverick surgeons and evidence-light therapies in treating heart problems raises real questions: Exactly what’s going on in this costly area of care?

Haider Warraich ── a cardiology fellow at Duke and author of “Modern Death,” a book exploring how technology and modern mores are changing patients’ end-of-life experiences ── deserves praise for raising major concerns about the too easy acceptance by doctors and surgeons of existing, device-based treatments for heart conditions. The headline on his Op-Ed in the New York Times summarizes well his tough point: Don’t Put That in My Heart Until You’re Sure It Really Works.

He, of course, points to recent challenges about the effectiveness of cardiac stents. They have been commonly used for years now ── in hundreds of thousands of surgeries ── supposedly to relieve blockages in patients with stable chest pain. But recent research has started to show they provide no benefit over drugs, and it was only after further study showed that a new kind of dissolving stent contributed to increased heart attack risks that the device maker pulled the already in-use product, Warrich notes.

insurersPP-300x296Patients who expect their health insurer will work in their interests to contain costs by medical providers might just as well hope for assistance from leprechauns, unicorns, or the tooth fairy.

Marshall Allen, a reporter for the Pulitzer Prize-winning investigative site ProPublica, has just penned a strong myth-busting piece, cross-posted on the National Public Radio site, about health insurers, writing:

The United States spends more per person on health care than any other country does. A lot more. As a country, by many measures, we are not getting our money’s worth. Tens of millions remain uninsured. And millions are in financial peril: About 1 in 5 is currently being pursued by a collection agency over medical debt. Health care costs repeatedly top the list of consumers’ financial concerns. Experts frequently blame this on the high prices charged by doctors and hospitals. But less scrutinized is the role insurance companies — the middlemen between patients and those providers — play in boosting our health care tab. Widely perceived as fierce guardians of health care dollars, insurers, in many cases, aren’t. In fact, they often agree to pay high prices, then, one way or another, pass those high prices on to patients — all while raking in healthy profits.

nags-300x166If you can get your favorite sports fans peeled away from the latest broadcast pro event  ─ whether it’s the basketball playoffs, hockey championship series, golf tourneys, or the heating up baseball season ─  a conversation of sorts could be sparked by dropping numbers on them. See what kind of rise you can get by telling them their data-driven obsession with improving their own athletic performance may be built on shoddy calculation.

In the “Moneyball,” statistics’ crazy world of contemporary sports and athletic fandom, that statement could be heretical. But the numbers-driven folks at the web site “528” deserve credit for digging into a popular but dubious approach employed by researchers in sports medical science: Magnitude-based inference, aka MBI. Their article’s worth a read, especially for wonks and the numerically inclined. For those who are less so, here’s a taste of what’s at stake, as 528 reported:

At first blush, the studies look reasonable enough. Low-intensity stretching seems to reduce muscle soreness. Beta-alanine supplements may boost performance in water polo players. Isokinetic strength training could improve swing kinematics in golfers. Foam rollers can reduce muscle soreness after exercise. The problem: All of these studies shared a statistical analysis method unique to sports science. And that method is severely flawed.

medicare-300x109Callous institutional inertia can allow dangerous doctors to keep harming patients. But media digging deserves credit for raising needed alarms when professional caregivers and others fail to step up to protect individuals as disparate as taxpayers, seniors, coeds, and heart transplant recipients.

The Milwaukee Journal-Sentinel and MedPage Today performed a public service, reporting that they found more than 200 doctors nationwide who surrendered a license, had one revoked, or were excluded from state-paid health care rolls in the previous five years  but somehow remained on the federal Medicare rolls in 2015.

This meant the problem doctors could keep bad practices afloat, in part because Uncle Sam ─ that’s taxpayers like you and me ─ paid these hundreds of MDs $25.8 million to care for seniors, among the nation’s most vulnerable patients.

Did you hear it? Was that a giant sigh of relief by Big Pharma executives around the globe? Or was it the air deflating from any Americans who still had high expectations that President Trump, as he had promised for more than a year, really would offer a quick, powerful, and effective public policy prescription to slash skyrocketing drug prices?

The stock market made a big bet that Big Pharma would do just fine, sending drug manufacturer stocks higher.

mdanderson-300x168With cancer care raining down more than $200 billion in billings on providers, giant hospitals and specialty treatment centers are resorting to unacceptable marketing and advertising hype, including pitches that “sell out” the credibility of science and a pillar of medical practice, commentators say.

Credit’s due to journalist Steve Salerno and the Wall Street Journal for a recent Op-Ed that’s worth a read as it makes the case outlined in the piece’s headline: “In war on cancer, truth becomes a casualty.”

Salerno blasts MD Anderson Cancer Center, Memorial Sloan-Kettering, and the Cancer Treatment Centers of America and others for waging costly, nationwide ad campaigns targeted at desperately sick patients. He faults these well-known institutions for relying on pure emotion and not fact to sell themselves. He says they resort to tugging at heart strings with “tear-jerker” patient testimonials, or by using pitch people with no other credibility than their celebrity.

mom-300x171Big Medicine can paper over its troubles with basic fairness by slapping fancy terms on them: take “health and gender disparities,” for instance. But doctors, hospitals, and the rest of us can’t make medical care more equitable, accessible, safe, and affordable without looking at inequities, square on.

That’s why the New York Times, Washington Post, and Associated Press deserve credit for recent deep digs into the struggles of women, poor women, and especially black women with modern medicine:

kidtv-300x225If Americans want to battle obesity, including among youngsters, one place to start is avoiding unhealthy food products hawked relentlessly by major league sports advertisers.

Weight woes plague grownups and show no signs of letting up — they’re increasing, instead, with 40 percent of Americans found to be obese in 2015 and 2016, a sharp increase over a decade earlier. The picture’s no prettier for young people, with the latest federal data showing the percentage of children ages 2 to 19 who are obese increased from 14 percent in 1999 to 18.5 percent in 2015 and 2016.

With studies showing that junk food and empty calories contribute significantly to making the nation an excessive waist-land, Vox, an online information site, deserves credit for pointing out how pervasive, insidious, and even accepted it has become for sports fans — especially young enthusiasts — to be barraged by advertising for fast and unhealthful meals, sugar-laden drinks and cereals, and foods full of fats, empty calories, and excess salt.

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