Articles Posted in Hospitals

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Breast cancer patients may get a welcome respite from one of the disease’s dreaded aspects — its aggressive and costly treatments. New research suggests that thousands of women with early-stage breast cancer who now are told to get chemotherapy don’t need it, while a larger, significant number of patients can benefit by halving the time they’re told to take an expensive drug with harsh side-effects, especially for the heart.

Although this information should be taken in a positive light, patients should consult with their doctors about appropriate treatment for their individual case.

The prospective shifts in breast cancer treatment, based on new findings, may add to rumblings and criticisms about over-treatment and whether doctors have taken too lightly the toll — physically, mentally, and financially — that this and other forms of cancer inflict on patients.

sessions-300x200As voters make up their minds about this fall’s mid-term races, they may wish to burn into their memories how the Trump Administration has dealt, so far, and especially in recent days, with government social programs that have huge effects on Americans’ health and lives.

Take, for example, the late-week, late night announcement by the U.S. Department of Justice that it will decline to defend yet another part of the Affordable Care Act, as 19 states, most red and led by Texas, attack Obamacare in the courts. The legal aspects of this decision will keep lots of law degree holders and their kindred men and women in black robes arguing, heatedly, for a while. There also may be huge political smoke clouds.

But keep in mind this basic fact from the actions by the Justice Department led by Attorney General Jeff Sessions: The nation’s crack legal team is asserting that it is unconstitutional for the ACA to bar insurers from declining coverage due to preexisting conditions.

mentalnyt-300x142Although Americans keep making progress toward ending the stigma associated with mental disorders, including trying to put public funding for the diseases’ treatment on a more even footing, patients with serious mental illness suffer unfairly and harshly still due to their conditions.

Dhruv Khullar, a doctor at NewYork-Presbyterian Hospital and a researcher at the Weill Cornell Department of Healthcare Policy and Research, has written a painful piece for the “Upshot,” an evidence-based column for the New York Times. His article, “The Largest Health Disparity We Don’t Talk About,” reports that:

Americans with depression, bipolar disorder or other serious mental illnesses die 15 to 30 years younger than those without mental illness — a disparity larger than for race, ethnicity, geography or socioeconomic status. It’s a gap, unlike many others, that has been growing, but it receives considerably less academic study or public attention. The extraordinary life expectancy gains of the past half-century [for most in this country] have left these patients behind, with the result that Americans with serious mental illness live shorter lives than those in many of the world’s poorest countries.

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.

medicaidmap-300x196Hundreds of thousands of poor, middle-class, old, sick, and young Virginians will get increased access to health care as the Commonwealth, joining 33 states and the District of Columbia, saw the crumbling of five years of fierce GOP-led opposition to an expansion of Medicaid under the Affordable Care Act, aka Obamacare.

Partisans, who reviled an enlarged role of the state in health care, got to pin a partisan fig leaf on the state’s move, by amending the social support program to force more recipients to work or show that they cannot, to receive Medicaid benefits.

Although neither the Trump Administration nor congressional Republicans are likely to heed it, Virginia and other states are sending a clear message that voters see health care as a right, not a privilege, and that voters will go to the polls to deal with those who claim to represent them but who make a near religion out of seeming to want to punish the sick and poor and to make costlier the already skyrocketing price of medical services.

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.

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.

Doctors and hospitals have a right to blow their own horn a bit when they’re onto something good, don’t they? What’s the harm? Plenty, as reported by Healthnewsreview.org, an independent, nonpartisan health information watchdog site.

As part of a series on patient harm from misleading media, Joy Victory, the site’s managing editor, details the tragic results from superficial news stories, typically on smaller media outlets, that deceive patients and their families about the Nuss procedure, a surgery to correct a congenital condition that results in a concave or “funnel” chest (see photo).

This is a serious operation, as I know from my practice. But as Victory points out, this hard, cold fact somehow gets glossed over in glowing reports about the surgery, written by news services and by reporters at smaller papers in South Carolina, Virginia, and Myrtle Beach, Fla., and even in a larger daily in Kansas City, Mo.

olympus-logo-300x64Undeterred by disclosures about the disastrous results of their growing use of dirty medical scopes, doctors, hospitals, and manufacturers have failed to figure how better to sanitize many of the devices. They, instead, may be taking short cuts that ensure the devices stay unsanitary when used in invasive procedures.

Chad Terhune, a reporter now with the independent Kaiser Health News service, deserves credit for staying with the story that he first started to break several years ago at the Los Angeles Times. He reported that tainted medical scopes, used for gastrointestinal exams and made by Olympus Corp. of Japan, were tied to at least 35 deaths since 2013,and had sickened dozens of other patients.

Medical safety experts revisited a key question raised by Terhune’s reporting and investigations by staffers with a U.S. Senate subcommittee: Can medical scopes, with their many and complex components, effectively be sanitized and what must be done?

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