Articles Posted in Conflicts of Interest

clown-246x300Social media have become a “circus” for some plastic and cosmetic surgeons to clown around in unprofessional ways, including: videos in which one doctor has cradled fat removed from a tummy-tuck like an infant and put a baby face on it using a Snapchat filter. Other costumed surgeons have posted visual displays of themselves dancing before surgery and showing off on camera procedures or with tissues they have removed.

The abuses have become so bad that faculty and students from Northwestern University’s medical school, after researching incidents online, have published a prospective social media code of ethics for plastic surgeons, calling for its adoption by specialists at their next major meeting.

Robert Dorfman, one of the Northwestern students and an author of the draft ethics proposal,  has described plastic surgery’s social media landscape “like the Wild West out there, with no guidelines or rules.” Clark Schierle, senior author of the guidelines, a plastic surgeon, and a medical school faculty member, has observed that practitioners in the field are “uniquely drawn to social media because we tend to do more marketing and we are a visual specialty.”

pills-drugs-300x215The epidemic of opioid drug abuse, which increasingly is claiming children’s lives, has plenty of blameworthy causes. Here’s a new one: health insurers which steer patients to cheaper, more addictive painkillers while playing Scrooge for less addictive but pricier alternatives.

Pro Publica, a Pulitzer Prize-winning investigative journalism site, and the New York Times get credit for their expose of  penny-wise and pound-foolish prescription management practices.

By analyzing “Medicare prescription drug plans covering 35.7 million people in the second quarter of this year,” the news organizations say they saw repeated patterns in which insurers and the spin-off businesses that run their drug payment plans (so-called pharmacy benefit mangers or PBMs) easily and quickly approve opioids for patients in pain, medications that cost relatively little. They throw up all kinds of obstacles, however, to doctors and patients who try to use less potent but more expensive drugs, including patches containing Butrans (a lesser opioid) or lidocaine. They also drag their feet on approving payments for addiction-fighting medications like Suboxone.

ravensLet’s give a hurrah for Maryland health officials — they threw a red flag at a high-tech startup that planned with the Baltimore Ravens football team to serve up a mass genetic screening test at a recent game. The blunt reality is this would have been genetic malarkey.

This incident should serve as a reminder, caveat emptor, to consumers, even in settings of good cheer. It should offer a caution to those who stage big public events, like sports leagues, that health matters and highly personal and confidential medical information isn’t handled well at spectacles.

Shall we also offer a Bronx cheer for Orig3N, a Boston company that offers direct-to-consumer “genetic testing,” and talks on its web site about everything from organ donation to regenerative and personalized medicine as well as its commitment to public service? The company, a new Ravens sponsor, planned a recent promotional Sunday when it would offer its mouth swab tests to 55,000 fans flocking to the contest against the Cleveland Browns.

paxil-300x300Psychiatric medications, which doctors have prescribed freely and patients have taken dutifully, not only may have demonstrated risks for the young but also under-considered problems for adults older than 40 — 1 in 7 of whom has filled a script, for example, for an antidepressant.

The New York Times has done a service by bringing to the fore some lesser known issues of psych meds by reporting on a successful lawsuit involving a 57-year-old Chicago lawyer. He apparently suffered from severe physical and mental agitation after he started taking paroxetine, the generic form of the brand-name drug Paxil. His anxiety became so acute, a jury found, the lawyer threw himself fatally in front of an oncoming train.

Antidepressants, including Paxil, long have been controversial for the young, especially after reports cropped up describing serious issues with their use. All such meds have carried a “black box” warning label, reviewed and approved by the federal Food and Drug Administration, warning that they increase the risk of suicidal thinking and behavior in children, teens, and those younger than 25.

flanursinghome-300x190Although Hurricanes Harvey and Irma have stormed off into the record books, their harms, particularly to health, persist for Texans, Floridians, and residents of the Caribbean. Recovery and return to normalcy will take the ravaged areas longer than many Americans realize, experts say. And they already are uncovering systemic woes, some fatal, with which planners and lawmakers will need to reckon with to better prepare for the next storm.

In Florida, for example, while hospitals, generally speaking, had adapted and rode out Irma maybe better than might be expected, nursing homes did not. They’re under new scrutiny, notably after eight residents died in an already troubled and roasting Hollywood, Fla., nursing home.

That incident refocused official attention on a sizable and particularly storm-afflicted population in the Sunshine State: its senior citizens. Whether in others’ care or ostensibly on their own, millions of older Floridians were left even more vulnerable after Irma, which cut off critical life services, including power, cooling, transportation, and access to medical services and food and other supplies.

jcgoldseal-300x300The nation’s leading watchdog of hospital safety and quality  is quick to hand out its “Gold Seal of Approval” and rarely penalizes care-giving institutions, even when state and federal officials find serious problems.

The Wall Street Journal deserves credit for its investigation of the Joint Commission, the nonprofit and industry-supported organization that is supposed to inspect and accredit hospitals nationwide. It does so for 80 percent of them, as well as for institutions serving military veterans, federal prisoners, and Native American patients in the Indian Health System.

Hospitals can either join the commission and undergo its accreditation process—including regular inspections that typically are announced in advance, conducted with flourish, and which can cost institutions tens of thousands of dollars depending on their size and membership levels—or they can be inspected by state and federal officials. Most choose the Joint Commission.

Medicine and law enforcement can be a combustible combination, as a widely publicized incident in a Utah emergency room has reminded. The ugly incident has underscored the importance of hospitals keeping big, upset guys with guns cordoned off from caregivers, as well as the importance of front-line medical personnel knowing, respecting, and protecting patients’ privacy rights about their medical treatment.

Nurse Alex Wubbels became a heroine for firmly and politely telling Salt Lake detectives that the law forbade them from ordering blood extraction and testing on patient William Gray. The unconscious truck driver turned out to be a reserve cop in a nearby small town, and he had been involved in a crash connected to a high-speed chase by Salt Lake officers.

Heroin-Fentanyl-vials-NHSPFL-1600x900-300x169A Missouri  Senator has accused Insys Therapeutics, a major drug maker, of conducting a sneaky campaign to get more pain-wracked cancer patients to use its synthetic and super powerful opioid drug, thus helping to fuel the wildfire spread of increasingly lethal and debilitating prescription pain killers.

Sen. Claire McCaskill and investigators from a Senate committee, as well as federal prosecutors, have painted a harsh picture of how Insys created a special unit to boost sales and use of Subsys, its spray form of the potent painkiller fentanyl.

Through an elaborate ruse—which included carefully crafted scripts and bogus phone numbers—Insys workers contacted prescription benefit management (PBM) firms, making them believe they were patients seeking a required pre-approval for their doctors to prescribe them Subsys.

nursinghome-300x200With more Americans than previously thought needing care in the nation’s nursing homes, will more of us start to pay greater attention to the unacceptable and under-reported elder abuse occurring there? And with calamities like Hurricane Harvey fresh in mind, will more sons and daughters, nephews and nieces, and other friends and loved ones take a bit of time now to think how safe their elder relatives’ care facilities might be and where they might go in catastrophic circumstance?

Although most previous research has indicated that just 35 percent of Americans will use a nursing home in later life, new study by the independent, nonpartisan RAND Corporation indicates that figure may be far too low. More than half (56 percent) of those now aged 57 to 61 will spend at least a night and likely much more time in nursing home care, RAND researchers found.

If seniors need the care, they stay on average 272 nights in nursing homes, though 10 percent of the population the researchers studied spent more than 1,000 nights in such facilities.

aarpAmerican workers have gotten back a little breathing room from corporations’ intrusive push to try to get them to surrender more of their personal, private health information as part of workplace wellness programs linked to company-provided health insurance plans.

This is due to a federal judge’s rejecting a rule by the federal Equal Employment Opportunity Commission that allows companies to describe the wellness programs as “voluntary,” even though workers may pay thousands of dollars if they decline to participate in them.

Such “coercive” company conduct is discriminatory, runs roughshod over workers’ health privacy rights, and is unfair, the AARP had asserted when it sued the EEOC to overturn its workplace wellness rule.

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