Misdiagnosis

May 23, 2018

Overrun by sports performance chatter? Can questions on MBI bust the bunk?

If you can get your favorite sports fans peeled away from the latest broadcast pro event ─ whether it’s the basketball playoffs, hockey championship series, golf tourneys, or the heating up baseball season ─ a conversation of sorts could be sparked by dropping numbers on them. See what kind of rise you can get by telling them their data-driven obsession with improving their own athletic performance may be built on shoddy calculation.

In the “Moneyball,” statistics’ crazy world of contemporary sports and athletic fandom, that statement could be heretical. But the numbers-driven folks at the web site “528” deserve credit for digging into a popular but dubious approach employed by researchers in sports medical science: Magnitude-based inference, aka MBI. Their article’s worth a read, especially for wonks and the numerically inclined. For those who are less so, here’s a taste of what’s at stake, as 528 reported:

At first blush, the studies look reasonable enough. Low-intensity stretching seems to reduce muscle soreness. Beta-alanine supplements may boost performance in water polo players. Isokinetic strength training could improve swing kinematics in golfers. Foam rollers can reduce muscle soreness after exercise. The problem: All of these studies shared a statistical analysis method unique to sports science. And that method is severely flawed.

January 10, 2018

Over-screening skews disease research and puts harsh burdens on seniors

by Patrick A. Malone

Medical over-screening and over-testing not only adds hundreds of billions of dollars in unnecessary costs to U.S. health care, it also may be skewing researchers’ understanding of what causes disease and imposing harsh burdens on older Americans.

Stat, an online health and medical news service, has highlighted an intriguing study from the Dartmouth Institute for Health Policy and Clinical Practice, whose researchers are well-respected for their work on their Atlas Project, which “documents glaring variations in how medical resources are distributed and used in the United States.”

Dartmouth researchers recently examined screening, especially for breast, prostate, and thyroid cancers, and found that over-testing, as Stat reported, may be “misleading doctors and the public about what increases people’s risk of developing cancers,” especially “the types of cancer that matter.”

January 9, 2018

Experts fret over how precise key basics may be in ‘precision medicine’

by Patrick A. Malone

Although billions of dollars and lots of positive public attention have been lavished on the promise of genetic-based “precision medicine,” this therapeutic approach to treating cancer and other serious diseases may need more scrutiny for basics of quality control.

National Public Radio deserves credit for airing some less-heard experts’ worries about the roles of at least two groups of little-seen and often-ignored medical specialists — pathologists and med techs — and how their common practices may undercut the potential of efforts to target disease treatments to individual patients based on maps of their genes.

Despite its powerful and progress-promising name, precision medicine relies on some old-fashioned, unchanged, and possibly problematic medical techniques, experts told NPR. Blood and tissue samples, which later will be analyzed with costly and supposedly state-of-the-art equipment, still get taken by med techs with limited training. Little attention typically gets paid to how they collect samples and how carefully they get handled before arriving in labs. They may sit on carts for hours, and they may be dragged through different parts of hospitals where temperatures vary widely and can hit extremes.

December 5, 2017

Does modern medicine give patients with major brain trauma really fair care?

by Patrick A. Malone

Nick Tullier once was a handsome, strapping sheriff’s deputy in Baton Rouge, La. Then, in a blink, he and five others were gunned down by a former Marine and black separatist who had come from Missouri to Louisiana to kill cops. Tullier was one of three deputies who survived the attack.

What happened next to him is part of a series worth reading in the Houston Chronicle, a year-long dig the newspaper has dubbed “Alive Inside.” The work asks whether doctors and hospitals across the country have stayed current with medical advances that maybe, just might, possibly offer greater glimmers of hope to patients like Tullier who suffer traumatic brain injuries.

Such individuals, the Chronicle carefully says, may too quickly be deemed too injured to survive. Doctors, in sincere acts of perceived compassion, may be too fast to urge family and loved ones to withhold or halt medical services for the brain-injured, partly out of the pragmatic reality that their recovery prospects remain poor.

November 21, 2017

Non-MDs do skin biopsies at many dermatology clinics, with sketchy results

by Patrick A. Malone

When the private equity firms move into skin cancer treatment, you know the story is not going to end well for patients. Think lots of treatments, but hit or miss on protecting you from serious cancers.

There’s a simple self-protection solution for the many boomers – like me – who need to get skin lesions regularly looked at by the skin doctor.

Just ask this question whenever you meet a new practitioner who proposes to examine your skin and cut or freeze off the growths there: What is the degree behind your name?

November 7, 2017

Why are doctors and hospitals so quick to turn to heart stents and robotic devices?

by Patrick A. Malone

Hundreds of thousands of times each year, doctors install stents (tiny wire cages) in blocked heart arteries, not only to provide better blood flow to the body’s most important muscle but also ostensibly to provide pain relief to patients. Surgeons also perform tens of thousands of different, minimally invasive procedures with the help of elaborate and expensive robot devices.

All these surgeries, which cost patients tens of thousands of dollars and carry real risks, are evidence-based and well-supported in their outcomes, right?

Wrong. And here’s hoping, not dead wrong.

November 6, 2017

United Medical Center’s woes deepen as ratings group rips DC-area hospitals

by Patrick A. Malone

Even as District of Columbia officials struggle with deepening woes at the United Medical Center (UMC), advocates from a national, independent, and nonprofit group have offered a dim review of hospitals in the DC area.

The bad news keeps piling on at UMC, a leading provider of medical care for communities of color in the District’s Southeast area and in Prince George’s County, Md.

To its credit, the sometimes locally slumbering Washington Post has put out a disturbing, well-documented report about the death of a 47-year-old HIV-AIDS patient in UMC’s nursing home care. As others witnessing the scene clamored for them to help, UMC nurses, the Post says, let the patient fall to the floor, where he sprawled in his own waste for 20 minutes while his caregivers argued with a security guard. When the patient finally was returned to his bed, he was dead.

November 1, 2017

As breast cancer patients know, over-testing and over-treatment are big woes

by Patrick A. Malone

Up to a third of medical spending goes for over-treatment and over-testing, with an estimated $200 billion in the U.S. expended on medical services with little benefit to patients. But getting doctors and hospitals to stop this waste isn’t easy, nor is it a snap to get patients to understand what this problem’s all about so they’ll push their health care providers to do something about it.

Which is why kudos go to Julie Rovner, of the nonprofit, independent Kaiser Health News Service, and National Public Radio for the recent story on how older women with breast cancer suffer needlessly and run up wasteful medical costs due to over-testing and over-treatment.

Rovner and Kaiser Health News worked with a medical benefit management company to analyze records of almost 4,500, age 50-plus women who received care for early-stage breast cancer in 2017. She found that just under half of them got a medically appropriate, condensed, three-week regimen of radiation therapy. Research has shown this care is just as effective as a version that’s twice as long, costs much more, and subjects patients to greater inconvenience, especially with more side-effects.

August 23, 2017

New disclosures deepen scandal over DC hospital’s risky obstetrics care

by Patrick A. Malone

Doctors and hospitals across the country push the frontiers of medical science every day, finding new ways to improve health care and to change and save lives. But at the same time, some of medicine’s basics—like delivering babies safely and protecting mothers’ well being—also keep getting botched, especially for poor and black women. It’s a national disgrace, and it’s on sad, terrible display in the growing scandal in Southeast Washington’s only full-service hospital, which recently was ordered to stop delivering babies.

Why? The Washington Post, which has done some good digging and needs to do more, says that health regulators for the District of Columbia have provided sketchy details to officials of United Medical Center, which serves the poor and predominantly African American residents of the neighborhoods east of the Anacostia River, as to why the public hospital’s obstetrics unit was shut down for 90 days.

The paper says United’s staff failed to properly care for a newborn to ensure the infant didn’t acquire HIV from the baby’s mother, who was infected and had a high viral load. The hospital didn’t test the baby properly for HIV, failed to deliver the child via cesarean to reduce the chances of HIV infection, and didn’t administer a recommended antiretroviral drug as a postpartum precaution.

August 4, 2017

With health care in tumult, patients should get their own records, GAO advises

by Patrick A. Malone

Although patients can protect their own health by getting copies of their medical records, few consumers get them, and fewer still take advantage of the federal government’s push to make records easily available electronically, one of Uncle Sam’s big public protection agencies reports.

The U.S. Government Accountability Office also warns that tumult in the nation’s health care system, notably in Congress’ roller-coaster deliberations to repeal and replace the Affordable Care Act, aka Obamacare, may disrupt patients’ relationships with caregivers. That makes it even more vital for consumers to have their health records.

The Association of Health Care Journalists deserves a tip of the cap for pointing to the GAO blog, where experts note that the ACA had supported a national push to get doctors and hospitals to adopt electronic health records with the aim of providing patients and caregivers more access and transparency about these crucial materials.