Articles Posted in Ethics

fda3smokewarns-300x166The U.S. government will try to tackle two of the toughest health care challenges around with new pushes involving graphic imagery and smoking prevention and the encouragement for doctors to screen their adult patients to better detect, avert, and treat drug abuse.

Both initiatives have their soft spots.

But officials say they must act in as many ways as they can. That’s because 480,000 people in the United States die each year from illnesses related to tobacco use, the American Cancer Society reports, adding, “This means each year smoking causes about 1 out of 5 deaths in the US.” Drug abuse and overdoses, meantime, killed more than 68,000 Americans in 2018 alone, exceeding the nation’s peak annual deaths from car crashes, AIDS or guns, the New York Times reported, based on data from the federal Centers for Disease Control and Prevention (CDC).

beaumonthospital-300x115When doctors become medical outliers, shouldn’t hospitals, colleagues, insurers, and the rest of us ask how and why an individual practitioner diverges so much from the way others provide care?

Olga Khazan details for the Atlantic magazine the disturbing charges involving Yasser Awaad, a pediatric neurologist at a hospital in Dearborn, Mich. As she describes him, for a decade he racked up hundreds of cases in which he is accused by patients of “intentionally misreading their EEGs and misdiagnosing them with epilepsy in childhood, all to increase his pay.” Khazan says his case “shines a light on the grim world of health-care fraud—specifically, the growing number of doctors who are accused of performing unnecessary procedures, sometimes for their own personal gain.”

In the malpractice cases that are unfolding against him, Awaad’s pay has become a central issue, with evidence showing his hospital contract rewarded him for boosting the number of screenings he ordered and diagnoses he made. Jurors have been told that Awaad, whose salary increased from 1997 to 2007 from $185,000 annually to $300,000, “turned that EEG machine into an ATM.” He earned bonuses exceeding $200,000, if he hit billing targets.

zolegensma-300x225Big 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.

axiosinsurancecost-300x170With 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.”

uclacampus-300x225It’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.

monsees-300x286Juul, 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.

reuterslogo-300x169The blame and shame for the opioid-drug overdose crisis that kills tens of thousands Americans annually has moved to yet another set of individuals and institutions now — judges and courts that handled Big Pharma lawsuits and may have been too quick to seal from the public information that would have warned of painkillers’ addictive and lethal characteristics.

Makers’ false claims about opioids and their problematic practices in promoting, selling, and distributing the drugs were hidden, too, in the “pervasive and deadly secrecy that shrouds product-liability cases in U.S. courts, enabled by judges who routinely allow the makers of those products to keep information pertinent to public health and safety under wraps,” Reuters reported.

The news agency dug deep into the judicial practices, finding:

logombh-300x61Nonprofit hospitals added almost $40 billion to their bottom lines in the last year and lavished a $3.5 million average salary on their chiefs. But their relentless grubbing for cash apparently was unsated still. The institutions, exempted from federal, state and local taxes in exchange for “community benefits” like charity care and financial support for patients in need, are acting like Dickensian debt collectors, harassing patients with lawsuits and wage garnishments.

Pro Publica, the Pulitzer Prize-winning investigative web site, partnered with MLK50, a local news organization, to describe the avalanche of financial travail with which Methodist Le Bonheur Healthcare has inundated its poor and middle-class patients in Memphis, Tenn. The hospital, affiliated with the United Methodist Church, has filed more than 8,300 lawsuits pursing “aggressive collection practices [that] stand out in a city where nearly 1 in 4 residents live below the poverty line.” As the journalists reported of Le Bonheur:

“Its handling of poor patients begins with a financial assistance policy that, unlike many of its peers around the country, all but ignores patients with any form of health insurance, no matter their out-of-pocket costs. If they are unable to afford their bills, patients then face what experts say is rare: A licensed collection agency owned by the hospital. Lawsuits follow. Finally, after the hospital wins a judgment, it repeatedly tries to garnish patients’ wages, which it does in a far higher share of cases than other nonprofit hospitals in Memphis. Its own employees are no exception. Since 2014, Methodist has sued dozens of its workers for unpaid medical bills, including a hospital housekeeper sued in 2017 for more than $23,000. That year, she told the court, she made $16,000. She’s in a court-ordered payment plan, but in the case of more than 70 other employees, Methodist has garnished the wages it pays them to recoup its medical charges.”

ECMO-300x212Medical ethicists and patient advocates are raising concerns about a big, costly, and often unsuccessful procedure that “pumps blood out of the body, oxygenates it, and returns it to the body, keeping a person alive for days, weeks or months, even when their heart or lungs don’t work,” the Kaiser Health News Service reported.

Extracorporeal membrane oxygenation or ECMO (eck-moe) is considered an appropriate treatment for some patients on death’s door.

But hospitals, to maintain their competitive business standing, are battling to get the equipment and staff to provide this therapy, which costs on average half a million dollars per patient.  The number of hospitals that can do ECMO has increased from 108 in 2008 to 264 now, with the number of ECMO procedures tripling since 2008 to almost 7,000 in the last count in 2014.

covervf-300x210As the nation’s opioid and drug overdose crisis deepens, it can be hard to watch as the “Not My Fault” crowd clucks about its blamelessness in pushing potent painkillers that have played a part in killing more Americans in 2016 and 2017 alone than lost their lives in the Vietnam War.

The latest NMF protagonists include:

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
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