Articles Posted in Ethics

covidhospitalizations08212021nyt-300x171The coronavirus keeps ripping through the country with a fourth, Delta-variant fueled surge that also is producing confounding, confused behaviors that only add to the pandemic’s considerable gloom.

The pandemic, which already has killed at least 635,000 Americans and infected just under 40 million of us, is slamming hospitals. More than 100,000 coronavirus patients, including rising numbers of children and younger patients, are jamming intensive care and other units in numbers not seen since the pandemic’s start (see New York Times graphic). This is slashing hospitals’ capacity to treat non-coronavirus patients, even many in serious shape. And hard-hit southern facilities braced for the double-whammy of a hurricane making landfall.

Disease deaths continue their scary spike, now averaging 1,000 a day. Florida is taking a bludgeoning from the disease, crashing records for infections, hospitalizations, and fatalities.

diabetesreuterrise-300x120More than 100,000 people in this country died last year due to diabetes. That’s 17% more than the year before. And in younger age groups, it’s even worse: deaths from diabetes climbed 29% last year  among those ages 25-44, federal data show.

The figures should raise huge alarms that diabetes, as exposed by the coronavirus pandemic, is “out of control,” reported Chad Terhune, Robin Respaut, and Deborah J. Nelson for Reuters news service.

Their investigation, including an analysis of federal data to draw a depressing depiction of diabetes’ significant damages to the health of millions of Americans, found that the pandemic only begins to show huge failures in the care of what should be a manageable illness:

bugatti-300x118If big hospitals really want to keep surgeons happy and provide them with greater comfort during procedures, why not build giant, sanitary glass garages next to operating rooms and let docs park their Bentleys, Lamborghinis, and Bugattis there for ogling and maybe even to take a break under the vehicles’ hoods?

Okay, maybe we’re being a bit too snarky.  Yet that hyperbolic scenario just might be cheaper and more medically justifiable than the sustained embrace by specialists and profit-seeking institutions of fancy robotic surgical devices costing more than $1 million annually — and for which patients, ultimately, pay. Here’s what the New York Times reported of yet another published meta-analysis of dozens of studies on the devices and their outcomes found:

“Surgical procedures performed with the aid of a robot is sometimes marketed as the ‘best’ form of surgery. But a recent review of 50 randomized controlled trials, testing robot-assisted surgeries against conventional methods for abdominal or pelvic procedures, suggests that while there may be some benefits to robotic surgery, any advantages over other approaches are modest … Some surgeons believe that these robots allow more precision during the operation, shorter recovery time, and generally better clinical outcomes for patients. But the review found that in many ways, compared outcomes from the robotic and conventional procedures showed little difference.

medscrewsuw-171x300Patients, regulators, hospitals, and doctors themselves need to open their eyes and ask tougher questions about the eyebrow-raising trend occurring among a specialized set of “sawboneses” — orthopedists and neurosurgeons.

Hundreds of them are profiting handsomely, not on their  medical skills  but rather their investments in and relationships with surgical hardware. The specialists also are increasingly reliant, in dubious fashion, on medical device salespeople.

Fred Schulte, an investigative reporter with the independent, nonpartisan Kaiser Health News service, has written a pair of detailed news articles raising yet more questions about medical devices, specifically the $3 billion that floods a peculiar pipeline between those who operate on patients’ backs, knees, hips, and shoulders and the companies that provide the surgical hardware for the procedures.

casey-150x150wyden-1-150x150Senate Democrats, including chairs of two powerful committees, have started to tackle the nightmarish problems that experts blame for allowing the coronavirus pandemic to take a terrible toll on vulnerable residents of nursing homes and other long-term care facilities.

Under a bill introduced by Ron Wyden, an Oregon senator and chair of the Senate Finance Committee (shown above, left), and Bob Casey Jr., a Pennsylvanian and chair of the Aging Committee (above, right), federal officials would both push and assist the facilities to improve health worker staffing, infection control, and regulatory oversight, notably through better inspections, the Associated Press and other news organizations reported.

The AP summarized the highlights of the Wyden-Casey measure, also supported by four other senators, thusly, noting it seeks to:

covidhotspotmap08142021nyt-300x180As the latest coronavirus surge worsens, public health efforts to quell the pandemic are targeting two groups that might be dubbed the can’t-s and won’t-s.

Federal regulators sought to assist the first group by approving coronavirus vaccination booster shots for a select group of patients — those whose compromised immune systems could not generate sufficient protection with standard shot regimens.

Experts say that individuals who have undergone organ transplants or who may be undergoing cancer treatments or otherwise have low immune systems may benefit from the booster shots.

From the It’s-about-time department: Nursing homes and long-term care facilities finally have started to require their health workers to get vaccinated against the coronavirus.

The federal Centers for Disease Control and Prevention has reported as of Aug. 6 that ~1.6 million long-term care residents and 1.3 million health workers in the care facilities were fully vaccinated.

But with coronavirus cases, hospitalizations, deaths, and community spread spiking this summer — especially due to the unvaccinated and the Delta variant — nursing homes have seen worrisome signs of their own of the pandemic’s resurgence. And they, along with other health care institutions, can no longer ignore the safety and effectiveness of the coronavirus vaccines, the New York Times and other media organizations have reported. As the newspaper noted:

fdanulogo-300x126The federal Food and Drug Administration may be putting patients’ safety at serious risk by allowing medical device makers to self-police their products, notably in making crucial determinations in reporting to the agency the severity of harms the devices inflict.

Using artificial intelligence techniques to scan a sampling of filings made by makers to the FDA over nine years, Christina Lalani, MD, of the University of California San Francisco, and colleagues found that just under a quarter of the documents mis-categorized cases in which medical devices were tied to patient fatalities.

These were not reported as deaths in an important FDA information source known as MAUDE (the Manufacturer and User Facility Device Experience database). Instead, they were “classified as either malfunction, injury, or missing (the report was not put in any category),” reported the medical site MedPage Today.

debtmedicalnytjuly2021-300x250A scandal of the U.S. health system may be far worse than imagined, with the medical debt sold to collection agencies alone amounting to a staggering $140 billion.

The $140 billion estimate came from researchers who published in a medical journal and found that such unpaid sums had increased significantly from an $84 billion calculation in a similar 2016 study, the New York Times reported (see excellent chart, courtesy of the newspaper).

The newspaper noted the debt estimate is an ugly number hanging over the finances of tens of millions of patients who are too often poor and uninsured — debtors who could benefit significantly, if politicians in their states had expanded Medicaid coverage for them as allowed under the Affordable Care Act:

lotsapills-300x200Consumers have gotten eyebrow-raising views of Big Pharma’s ugly business practices and the tough and sometimes sketchy efforts to rein in the industry’s ravenous pursuit of profits — in settling claims over distributors inundating the country with lethal painkillers, or with a maker’s behind-the-scenes campaign to win U.S. approval of an Alzheimer’s medication based on dubious data.

Patients are unlikely to come out ahead, or even satisfied with the outcomes of the cases involving how Johnson & Johnson (J&J), Cardinal Health, AmerisourceBergen, and McKesson handled opioids, and how Biogen and the Food and Drug Administration have dealt with Aduhelm.

A major opioids settlement

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