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August 20, 2019

As NFL talks up lesser head harms, study shows repeated slams injure brains

Although commentators and pro football itself have argued that rule changes by the National Football League have notably reduced possible head harms, new evidence from college athletes shows that even knocks that aren’t severe enough to be deemed concussions may injure young brains.

Those findings come from a University of Rochester study based on brain scans and helmet data from members of the school’s Division III football team (shown above), the New York Times reported.

Researchers scanned the athletes’ mid-brain area twice, once before the season kicked off and at its end. They did so because that region would most likely show the effects of impacts, including those that might be tougher to gauge in other areas of the brain. They also compiled data from special equipment on players’ helmets, registering the number and intensity of every impact — not just from player collisions but also when athletes hit the ground.

August 14, 2019

For patients’ sake, U.S. must slap down Big Pharma chiseling on tests, trials

by Patrick A. Malone

Big Pharma is testing crucial boundaries in the way that the nation determines the safety and effectiveness of prescription medications. And regulators, for patients’ sake, need to shove back — hard.

The concerning incidents involve “pay to play” clinical trials and “manipulated” data submitted to the federal Food and Drug Administration by maker Novartis as part of the approval process for a gene therapy drug with a sky-high price.

Neither instance, officials insist, had immediate effects in endangering patients. But both show extreme practices and conduct that regulators should slam to a halt.

August 13, 2019

Would workers really be sad if health insurers didn’t grab a third of their pay?

by Patrick A. Malone

With the 2020 presidential campaign obsessing early about health insurance rather than costly health care overall, voters may wish to reframe their thinking about coverage and candidates’ views on making it affordable. Their chief query may need to be this: Just how much of the vig should the bagman take?

That may be a blunt a way to put it, but is the vernacular of the criminal “protection” racket all that out of place here? Michael Hiltzik, a financial columnist for the Los Angeles Times, makes pretty much the same argument, that the bagman’s share ought to be zero. Why not get rid of health insurers, he asks in a bit of evidence-based hyperbole? He finds the companies don’t fulfill much of a public mission, save, as a former insurance executive describes it, to make themselves money and to persuade all of us that they are essential. Indeed, as Hiltzik sees it, insurers are not just a rip-off but a failure in their own terms:

“Let’s start by examining what the insurers say are their positive contributions to healthcare. They claim to promote ‘consumer choice,’ simplify ‘the health care experience for individuals and families,’ address ‘the burden of chronic disease,’ and harness ‘data and technology to drive quality, efficiency, and consumer satisfaction.’ (These claims all come from the website of the industry’s lobbying organization, America’s Health Insurance Plans (AHIP). They’ve achieved none of these goals. The increasingly prevalent mode of health coverage in the group and individual markets is the narrow network, which shrinks the roster of doctors and hospitals available to enrollees without heavy surcharges. The hoops that customers and providers often must jump through to get claims paid impose costly complexity on the system, not simplicity. Programs to manage chronic diseases remain rare, and the real threat to patients with those conditions was lack of access to insurance (until the Affordable Care Act made such exclusion illegal). Private insurers don’t do nearly as well as Medicare in holding down costs, in part because the more they pay hospitals and doctors, the more they can charge in premiums and the more money flows to their bottom lines. They haven’t shown notable skill in managing chronic diseases or bringing pro-consumer innovations to the table.”

August 12, 2019

Gun violence is a public health crisis. Research and treatment are needed now.

by Patrick A. Malone

With back-to-back-to-back incidents of mass gun violence killing almost three dozen children, women, and men, can this nation muster the political courage to treat this lethal scourge as a public health menace?

Can it, finally, green light and fund rigorous research that could inform public policies that both could protect Americans’ Second Amendment rights while also reducing the estimated 40,000 or so firearm deaths that occurred in 2018 alone?

For what it is worth, there is considerable and (what should be) convincing evidence that:

August 9, 2019

Another abuse scandal may change ‘The Talk’ with college-bound students

by Patrick A. Malone

It’s that time of year when parents send their kids off to schools and opportunities near or far away. While this should be a mostly welcome happening, sadly grownups may want to have The Talk with their young adults before they go to college or university.

No, they won’t be discussing just the birds and the bees. They may be talking about an ugly necessity — how young people must know appropriate boundaries and acceptable conduct by adults with responsibilities for their care, specifically athletic coaches and health providers at colleges and universities. This is an issue of rising concern for young women and men.

Yet another sexual abuse scandal has erupted involving dozens of young men in track and field programs, spanning the globe for decades, ESPN reported. The tawdry incidents focus on Conrad Montgomery Avondale Mainwaring, now 67 and hobbled by hip problems.

August 5, 2019

Defense bill may offer active service personnel a way to win back key rights

by Patrick A. Malone

Although members of Congress have fled the nation’s capital for their annual August recess, there’s guarded optimism that lawmakers may be open to reversing a seven-decades-old U.S. Supreme Court ruling that bars active duty military personnel from their constitutional right to pursue in the civil justice system claims that they have suffered harms while seeking medical services.

Advocates of this change saw cause for optimism that President Trump met briefly in July in North Carolina and encouraged Army Sgt. 1st Class Richard Stayskal, a terminally ill Green Beret who has become the focus of efforts to fixing the Federal Tort Claims Act (FTCA), Bloomberg news service reported. Jackie Speier, a California Democratic congresswoman, introduced a bill named after Stayskal and that would allow troops to file medical malpractice suits in federal court, because, as Bloomberg said:

“Stayskal went to Womack Army Medical Center at Fort Bragg in 2017 after feeling suffocated and coughing up blood, but the hospital misdiagnosed him with pneumonia during two visits, according to his congressional testimony before the House Armed Services Committee. By the time he saw a civilian doctor six months later, the lung tumor causing the problems had doubled in size. The tumor had showed up in X-rays done before he went to dive training, but nobody told Stayskal or diagnosed him.”

July 31, 2019

Juul denies it’s like Big Tobacco. But it just got caught targeting kids. Again.

by Patrick A. Malone

Juul, the nation’s dominant maker and seller of vaping devices, may want to deny it looks, acts, or models itself after Big Tobacco. A U.S. House subcommittee, however, has caught the San Francisco-based company in one of the prime profit-boosting practices of its health-killing precursor: targeting young users.

Though it insists it neither wants nor has it sought older teens as its customers, Juul spent tens of thousands of dollars and campaigned in recent months with what was purported to be a health education curriculum to reach out to show itself in most favorable fashion to young people in schools, summer camps, and youth programs, House investigators assert.

They told U.S. representatives on the economic and consumer policy subcommittee that they reviewed 55,000 documents to determine that “Juul operated a division that persuaded schools to allow the company to present its programming to students and paid the schools in several instances at least $10,000 to gain access to students during classes, summer school and weekend programs. The effort ended last fall and involved about a half dozen schools and youth program,” the Washington Post reported.

July 28, 2019

Can lives be saved with lessons learned from a space pioneer’s botched care?

by Patrick A. Malone

Neil Armstrong served as a naval aviator, test pilot, federal administrator, and a university professor. He earned his place in history as space pioneer — the first astronaut to walk on the moon. The American hero, who spoke the legendary phrase about “one small step for man and one giant leap for mankind,” also now offers a textbook case about nightmares in health care. Can others avoid these by learning about what happened to him?

As the nation celebrates the 50^th anniversary of Armstrong’s Apollo 11 flight, an anonymous tipster has disclosed information to two news organizations that his death was due to botched care. His family, which included a lawyer who represented their interests, reached a $6 million settlement with the community hospital involved.

Armstrong was known for keeping out of the media and public glare. His family kept that tradition in keeping private how he died in 2012, why, and the tense negotiations that resulted in the sizable payment to them by the hospital. Full information about his case may never be fully disclosed. But it already provides a possible series of check points for patients to protect themselves and their loved ones in dealing with doctors and hospitals:

July 26, 2019

For patients facing high-risk operations, an alarm on hospital surgical volumes

by Patrick A. Malone

Would a major league baseball team start a pitcher who played only once in the season for the deciding game of the World Series? Would passengers want to be aboard a jet whose pilot flew just once a year? Would any high-end sports car owner let a mechanic under the vehicle’s hood if she fixed that model one time every 365 days?

If rigorous tasks benefit from regular, quality practice — and they do — then why do hospitals allow low-volume surgeons to undertake procedures they rarely perform? That’s a tough question posed by new research from the Leapfrog Group, a national nonprofit organization seeking to improve the quality and safety of American health care.

Leapfrog, working with medical experts, identified eight high-risk surgeries and sought to estimate from rigorous published research the correlation between how often surgeons perform these and their procedures optimal outcomes.

July 25, 2019

Waste, fraud, and abuse? For health insurers, fat profits matter more

by Patrick A. Malone

What happens when a whistle blower provides detailed information about a burly Texan — with convictions for felony theft and felony injury of a child — and a burgeoning scam to rip off health insurers for $25 million? Pretty much nothing. For years.

If that sounds outlandish, investigative reporter Marshall Allen has a doozy of a tale to tell about a crook in suburban Fort Worth, Texas named David Williams. His long-running defrauding of some of the nation’s biggest health insurers matters to us all because, as Allen reported for the Pulitzer Prize-winning investigative site ProPublica:

“There are a host of reasons health care costs are out-of-control and routinely top American’s list of financial worries, from unnecessary treatment and high prices to waste and fraud. Most people assume their insurance companies are tightly controlling their health care dollars. Insurers themselves boast of this on their websites. In 2017, private insurance spending hit $1.2 trillion, according to the federal government, yet no one tracks how much is lost to fraud. Some investigators and health care experts estimate that fraud eats up 10% of all health care spending, and they know schemes abound. Williams’ case highlights an unsettling reality about the nation’s health insurance system: It is surprisingly easy for fraudsters to gain entry, and it is shockingly difficult to convince insurance companies to stop them. Williams’ spree also lays bare the financial incentives that drive the system: Rising health care costs boost insurers’ profits. Policing criminals eats away at them. Ultimately, losses are passed on to their clients through higher premiums and out-of-pocket fees or reduced coverage.”