Articles Posted in Misdiagnosis

colorectalcancerhotspotmap-300x230While technological advances may help provide crucial warnings to young men, especially those who are black, about their heightened risk of early-onset colorectal cancer, the rise of other high-tech diagnostic aids may only worsen built-in, harmful racial biases in an array of medical practices.

Researchers at the University of Chicago, to their credit, have sought the assistance of health providers across the country to inventory and assess increasingly common medical software and the algorithms on which they rely to ensure whiz-bang decision-making tools don’t discriminate against patients of color.

The early results are distressing, showing how well-intentioned experts inject prejudices into programs that can lead to racially unfair choices about patient care. Ziad Obermeyer, an emergency medicine physician and co-author of the Chicago research, told Stat, the science and medical news site, this about algorithms used in many diagnostic tools:

surgerylown-300x196When it comes to hospitals performing low-value tests or procedures and putting older patients at increased risk, Dixie may have little to whistle about.

The Lown Institute, a respected and nonpartisan think tank that says it “believes a radically better American health system is possible,” has published a new hospital index that puts dozens of southern institutions in a dubious light.

That’s because institute researchers scrutinized federal Medicare records on more than 1.3 million fee-for-services provided to older patents at more than 3,300 hospitals nationwide. They reported in findings published in an online part of the Journal of the American Medical Association that “hospitals in the South, for-profit hospitals, and nonteaching hospitals were associated with the highest rates of overuse” of health care services.

demeter-300x261It’s not an invitation to pile on the ice cream, cake, and candy. But older adults may get to say pshaw to the finger-wagging they may have endured from doctors and loved ones about their raised blood sugar levels and the condition that specialists ginned up to caution them about it: prediabetes.

As the New York Times reported, a newly published study by researchers at Johns Hopkins and elsewhere looked at data over six years on almost 3,500 older patients with elevated blood sugar measurements and found they “were far more likely to have their blood sugar levels return to normal than to progress to diabetes. And they were no more likely to die during the follow-up period than their peers with normal blood sugar.”

This is an important finding, the newspaper reported, quoting Elizabeth Selvin, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health in Baltimore and the senior author on the study:

docnotes-300x154Millions of Americans may be finding that their doctors routinely refer to them with terms like SOB and BS. But patients will be better off with this knowledge, once they learn how to translate medical abbreviations.

The Associated Press reported that hospitals and health care systems nationwide quietly are complying with deadlines, and, under a 2016 federal law, are opening up convenient, fast access to patients to not only view and access their electronic health records but also physicians’ notes about their care. As the AP wrote:

“If you already use a patient portal such as MyChart to email your doctor or schedule an appointment, you may soon see new options allowing you to view your doctor’s notes and see your test results as soon as they are available. You may get an email explaining where to look, how to share access with a caregiver and how to keep other eyes off your information. Many people won’t notice a change. About 15% of health care systems already are letting patients read doctor notes online without charge. That means about 53 million patients already have access to their doctor’s notes.”

colorscreen-300x168An important federal advisory group has joined with medical specialists in recommending a change in the age at which patients should start screening for colorectal cancer, to age 45 and not the current 50 years old.

Earlier detection of bowel issues could save lives, the U.S. Protective Services Task Force (USPSTF) has decided, with the influential medical group issuing a draft screening guidance and posting it online for public and expert comment.

Clinicians have reported for a while now that they are seeing more cases of colorectal cancers in younger patients, and their treatment might have better outcomes if it could be started earlier, too. As the New York Times reported:

javaid-300x169A Virginia criminal case, while focusing on claims of fraud against the federal government, also has exposed a long-running and nightmarish pattern of what prosecutors assert has been a Chesapeake gynecologist’s rampant mistreatment of his patients, many of them women of color and poor.

Dr. Javaid Perwaiz is on trial because authorities say he “manipulated records to cover crimes that enriched him but endangered pregnancies, sterilized women unnecessarily, and pressured them into needless procedures to finance his lavish lifestyle,” the Washington Post reported.

The newspaper’s articles, as well as the efforts by the FBI and federal prosecutors to develop the charges against the jailed specialist, raise disturbing questions about not only Virginia medical regulators but also the hospitals where the gynecologist practiced and colleagues who have described a “frenzied environment in which hospital staff struggled to keep pace with Perwaiz as he rushed from procedure to procedure.”

covidtestswab-282x300The federal agency that regulates nursing homes and other long-term care facilities not only has cracked down on them with tough new requirements for coronavirus testing of their staff. The Centers for Medicaid and Medicare Services also has flogged its plan to provide facilities with testing equipment and sample tests.

While owners and operators have grumbled about the whole process, the state of Nevada has gone a step further: Enough, its health officials have decided. They briefly halted as unacceptable the CMS tests for the virus because they say they are flawed and may put nursing home residents at risk.

Besides casting yet more doubt on CMS’s poor pandemic response with long-term care facilities,  Nevada’s balk — rescinded abruptly after federal threat — may offer an important take-away to members of the public, already flooded with findings about the novel coronavirus:

alztest-300x79It isn’t just the testing for the novel coronavirus that has already anxious Americans upset these days. Controversies also are swirling around existing and developing ways for experts to screen older patients for cognitive decline, namely  dementia and its most familiar form,  Alzheimer’s disease.

Alzheimer’s disease, which accounts for 60%-80% of dementia cases, is the sixth leading cause of death in the United States overall and the fifth leading cause of death for those age 65 and older, researchers say. Medical scientists have engaged in furious efforts for a while now to determine the condition’s causes and to create treatments for it — a response that is sorely lacking now.

But the New York Times reported that experts believe they are nearing a better way to screen and diagnose the illness using the blood rather than current “expensive methods like PET scans of the brain and spinal taps for cerebrospinal fluid.” As reporter Pam Belluck wrote:

algorithmwoes2-300x200High-tech wizards may be pushing medicine into a brave new world where important medical decisions rely on supposedly data-driven findings that also may be rooted in an old malignancy: discrimination against black patients.

A new study published in the New England Journal of Medicine warns that race-based tools and formulas, algorithms aimed to assist doctors in speeding up their diagnosis and treatment in such areas as heart disease, cancer, and kidney and maternity care, improperly steer blacks away from therapies commonly given to whites without sound reasons, the New York Times reported:

“The tools are often digital calculators on web sites of medical organizations or — in the case of assessing kidney function — actually built into the tools commercial labs use to calculate normal values of blood tests. They assess risk and potential outcomes based on formulas derived from population studies and modeling that looked for variables associated with different outcomes. ‘These tests are woven into the fabric of medicine,’ said Dr. David Jones, the paper’s senior author, a Harvard historian who also teaches ethics to medical students. ‘Despite mounting evidence that race is not a reliable proxy for genetic difference, the belief that it is has become embedded, sometimes insidiously, within medical practice,’ he wrote.”

calguardvirusaid-300x169The coronavirus outbreak spreading across the globe may be providing Americans with an unhappy view of the dirty downsides of the too-often dysfunctional U.S. health care system as it grapples with spiking Covid-19 infections.

Congress has appropriated more than $8 billion, so the federal government can provide the nation the support it needs in battling the respiratory illness that exploded out of central China a few weeks ago. Almost 100,000 people globally have been infected with the virus, which has killed thousands. The deaths in this country are rising into the dozens, while infections are increasing into the hundreds. In Italy, the government took a drastic step in dealing with steeply rising infections and ordered a virus-related quarantine of much of the northern part of the country — a tough lock down because the Lombardy area is the largest economic powerhouse of the nation.

In the U.S., federal efforts to stockpile needed medical supplies, notably masks, gloves, and gowns — personal protective equipment or PPEs — continue to lag. The administration is under fire for its slow and ineffectual roll-out of virus testing kits. Vice President Pence promised that big numbers of screening supplies would be available quickly — at least 1 million, asap — but he since has been forced to walk back that pledge. Even as he talked about 75,000 test kits becoming available soon, the Atlantic magazine reported that as few as 1,895 Americans have been tested so far for the virus.

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