Primary Care

September 26, 2019

While it’s still warm and sunny, saunter in for that annual flu shot

The weather may be sunny and temperate, the seasonal foliage a slowly changing delight to behold. But the savvy are prepping for sterner days ahead. It’s that time of year when doctors and public health officials urge us all to get that annual flu shot.

It’s never easy to forecast the severity with which influenza will sweep the country. But early indications — including a child’s death already attributed to the illness — suggest this may be a bad year for the bug.

Don’t downplay the harms of this all-too-common sickness: The federal Centers for Disease Control and Prevention estimates that there were as many as 43 million flu illnesses in this nation in the 2018-19 season, with more than 20 million cases serious enough to cause patients to seek medical care. The CDC says there were as many as 647,000 hospitalizations and up to 61,200 flu-related deaths. That toll included more than 100 children killed by flu.

September 24, 2019

Administration actions give us all plenty of reasons to not breathe easy

by Patrick A. Malone

Even as investigations deepened into the harms caused by vaping and e-cigarettes, the Trump Administration confounded those concerned with public health and the environment with rollbacks of legal ways to get vehicles to be cleaner and less polluting and of measures to ensure food safety, notably via changes in inspections of long problematic pork producers.

Voters in the 2020 elections may wish to take note of these and other mounting issues — including proliferating “skimpy” health insurance plans — in which the administration zigs and zags on policies that it promises are intended for the public good, despite considerable evidence to the contrary.

President Trump made public his administration’s decision to revoke federal approval of California setting industry-leading vehicle emission standard even as he fund-raised in the Golden State.

September 22, 2019

It’s a season to get ripe view of money-grasping Big Pharma and plutocrats

by Patrick A. Malone

For those who get a rise out of following the plight of plundering plutocrats, forget about pop culture shows like Succession, Dynasty, or Empire. Instead, it may be worth peeking in on the true-life Sackler family saga. It also underscores the truth of this idea: Never get between Big Pharma and a buck.

The Sackler story, turning on the fate of the family’s Purdue pharmaceutical firm and a fortune estimated at $13 billion, has been ripe with recent developments, including a potential settlement of thousands of claims by states, counties, cities, Indian tribes, and others — all claiming billions of dollars in damages due to the maker’s aggressive and less than accurate sales and marketing of its prescription painkiller OxyContin.

With a federal judge in Ohio consolidating and pushing a “global resolution” of a giant number of opioid-related lawsuits, Purdue and the Sacklers announced a tentative settlement of many of the governments-filed claims. Roughly half the plaintiffs were eager to get what money they could — to not only help constituents staggered by damages due to opioids, overdoses, and addictions, but also to refill government coffers depleted by the huge costs of dealing with nightmares caused by the painkillers.

September 20, 2019

Nursing homes and long-term care facilities may be infection ‘cauldrons’

by Patrick A. Malone

The battle to reduce the sky-high cost of hospital care may have created its own unforeseen and harmful consequence: By hastening to get patients out of traditional hospitals and into skilled nursing facilities and long-term care centers, doctors and policy-makers may be contributing to a medical nightmare — serious infections acquired in health care institutions.

The New York Times reported that “public health experts say that nursing facilities, and long-term hospitals, are a dangerously weak link in the health care system, often understaffed and ill-equipped to enforce rigorous infection control, yet continuously cycling infected patients, or those who carry the germ, into hospitals and back again.”

Hospital-acquired infections (HAIs) pose significant risks to already ill and injured patients, as well as adding to the fearsome costs of institutional care, the Leapfrog Group, an independent patient safety and advocacy group has found. As Leapfrog has reported:

September 18, 2019

There hospitals go again: UVA Health backpedals on draconian debt collection

by Patrick A. Malone

Is a public pillorying the only way to stop big hospitals from pursuing patients for medical debt with the zeal of demons from the underworld?

The University of Virginia Health System — an enterprise that racked up an $87 million operating profit on revenue of $1.7 billion in the fiscal year ending in June and that holds stocks, bonds and other investments worth about $1 billion — has become the latest institution to get a journalistic blaming and shaming for extreme debt collection practices that would make proud Inspector Javert in Les Miserables.

The independent, nonpartisan Kaiser Health News Service and the Washington Post deserve credit for their investigation into UVA avariciousness. As KHN reported of the state operation:

September 17, 2019

With GOP still tearing at ACA, uninsured rate rises for first time in decade

by Patrick A. Malone

The Grand Old Party may have just won the dictionary definition of a Pyrrhic Victory. That’s because Republicans’ decade-long assault on the Affordable Care Act his finally showing predictable results, with the share of Americans lacking health insurance increasing for the first time in 10 years.

The rate and number of people without health insurance increased from 7.9%, or 25.6 million, in 2017 to 8.5%, or 27.5 million, in 2018, officials reported.

The nation’s children got a kick in the face, too, with almost half a million more youngsters uninsured in 2018 versus 2017 — a decline attributable mostly to a reduction in the number of kids covered by safety net programs like Medicaid and the Children’s Health Insurance Program aka CHIP.

September 15, 2019

Trump administration now seeks to vaporize vaping, banning candy flavorings

by Patrick A. Malone

After standing to one side while vaping hooked a generation of young Americans on nicotine, the Trump Administration has now abruptly decided to try to vaporize youthful vaping by banning candy-like flavorings favored by e-cigarette users.

The president and Alex Azar, the chief of the Health and Human Services agency, announced the latest e-cigarette and vaping crackdown. It still must be defined in regulations, practices, and the financial support for the federal Food and Drug Administration to enforce it. FDA Commissioner Ned Sharpless and First Lady Melania Trump also participated in the Oval Office session.

The White House announcement came as public officials add daily to the toll of a sudden outbreak of reported deaths (at least a half dozen) and serious respiratory harms (hundreds of cases in three dozen or so states) blamed on vaping. Investigations continue as to the cause of the e-cigarette-related fatalities and injuries.

September 13, 2019

Home care for the aged has become a quiet calamity for all involved

by Patrick A. Malone

Americans are confronting a care-giving calamity with the elderly at home, and the alarms are sounding loudly about it. But are experts and politicians grasping the severity of this crushing health care shortfall?

The New York Times, Vox, Washington Post, and Forbes all published detailed and solid news articles about the nation’s quiet nightmare with the workforce needed to deal with the booming population of aging baby boomers.

Just a reminder: This is a huge group that is graying rapidly, with 10,000 boomers each day turning 65 and this startling reality continuing for the next decade or so. Seniors long have said they prefer to age at home, that they dread and may not be able to afford nursing home care, and they are panicked about who will help them in their daily lives as they become debilitated, especially with dementia or Alzheimer’s — conditions predicted to explode in prevalence and cost as the nation’s elderly population increases.

September 12, 2019

Go figure: In era of Big Data, numbers and statistics still bedevil medicine

by Patrick A. Malone

Big data and numbers may seem to drive the world these days, but human factors can play a dizzying role when it comes to statistics and medical treatments.

For those fascinated by numeracy in health care, writer Hannah Fry, in a readable New Yorker essay, details how medicine and patients alike have been bedeviled by attempts to quantify life-and-death decision making.

She tracks centuries of investigators experiments in applying rationality, logic, and mathematics to human lives and their care by doctors and others, reporting about Adolphe Quetelet, an 1830s Belgian astronomer and mathematician:

September 10, 2019

Consumers blame, shame and prod corporations to win health safeguards

by Patrick A. Malone

Consumers, regulators, politicians, and journalists need to keep pressing big corporations to better protect the public’s health because such campaigning can work.

It has led to steps that may cut down on reckless promotion of expensive, burgeoning, and dubious treatments involving purported stem cells. It may make vehicles safer, so children and pets don’t die or suffer heat injury when mistakenly left in rear seats.

More tough work still needs to be done, however, with a new version of the persistently problematic off-road vehicle, and, indeed, with the federal agency that oversees road safety.