Primary Care

July 30, 2019

Voluntary recall of textured device raises more alarms about breast implants

An Irish medical manufacturer voluntarily withdrew its textured breast implant and related tissue expanding devices from markets after the federal Food and Drug Administration tracked a spike in a rare cancer and deaths tied to the products and asked that they be recalled.

U.S. regulators, the New York Times reported, lagged their European counterparts by almost a year in acting to protect women seeking cosmetic and reconstructive procedures involving the Allergan implant:

“Worldwide, 573 cases and 33 deaths from the cancer have been reported, with 481 of the cases clearly attributed to Allergan Biocell implants, the F.D.A. said. Of the 33 deaths, the agency said its data showed that the type of implant was known in 13 cases, and in 12 of those cases the maker was Allergan.”

July 28, 2019

Can lives be saved with lessons learned from a space pioneer’s botched care?

by Patrick A. Malone

Neil Armstrong served as a naval aviator, test pilot, federal administrator, and a university professor. He earned his place in history as space pioneer — the first astronaut to walk on the moon. The American hero, who spoke the legendary phrase about “one small step for man and one giant leap for mankind,” also now offers a textbook case about nightmares in health care. Can others avoid these by learning about what happened to him?

As the nation celebrates the 50^th anniversary of Armstrong’s Apollo 11 flight, an anonymous tipster has disclosed information to two news organizations that his death was due to botched care. His family, which included a lawyer who represented their interests, reached a $6 million settlement with the community hospital involved.

Armstrong was known for keeping out of the media and public glare. His family kept that tradition in keeping private how he died in 2012, why, and the tense negotiations that resulted in the sizable payment to them by the hospital. Full information about his case may never be fully disclosed. But it already provides a possible series of check points for patients to protect themselves and their loved ones in dealing with doctors and hospitals:

July 26, 2019

For patients facing high-risk operations, an alarm on hospital surgical volumes

by Patrick A. Malone

Would a major league baseball team start a pitcher who played only once in the season for the deciding game of the World Series? Would passengers want to be aboard a jet whose pilot flew just once a year? Would any high-end sports car owner let a mechanic under the vehicle’s hood if she fixed that model one time every 365 days?

If rigorous tasks benefit from regular, quality practice — and they do — then why do hospitals allow low-volume surgeons to undertake procedures they rarely perform? That’s a tough question posed by new research from the Leapfrog Group, a national nonprofit organization seeking to improve the quality and safety of American health care.

Leapfrog, working with medical experts, identified eight high-risk surgeries and sought to estimate from rigorous published research the correlation between how often surgeons perform these and their procedures optimal outcomes.

July 23, 2019

As overdose deaths dip, new outrages disclosed on Big Pharma and opioids

by Patrick A. Malone

The nation may be hitting an inflection point in the opioid crisis. But Big Pharma, regulators, and politicians have much to answer for prescription painkillers’ terrible toll and their sluggish efforts to reduce the tens of thousands of casualties.

The spare good news about U.S. drug abuse — the first drop in overdose deaths since 1990 — came from the federal Centers for Disease Control and Prevention. The agency also warned its findings were freighted with many “yes, but …” elements, including:

The reported 5% decline occurred in deaths from prescription opioids;

July 22, 2019

Rising antibiotic resistance elevates all-too-common UTIs as health concern

by Patrick A. Malone

For kids, women, and seniors, the three letters U, T, and I long described an uncomfortable, inconvenient, and embarrassing condition. The time, though, may have past for the swift and easy relief that diagnoses of urinary tract infections once might have brought. Instead, doctors are expressing concern that the bugs that cause all-too-common UTIs are becoming different and antibiotic resistant.

As the New York Times reported, the shifts already are meaning “more hospitalizations, graver illnesses and prolonged discomfort from the excruciating burning sensation that the infection brings.” The newspaper added:

“The New York City Department of Health has become so concerned about drug-resistant UTIs … that it introduced a new mobile phone app this month that gives doctors and nurses access to a list of strains of urinary tract infections and which drugs they are resistant to. The department’s research found that a third of uncomplicated urinary tract infections caused by E. coli — the most common type now — were resistant to Bactrim, one of the most widely used drugs, and at least one fifth of them were resistant to five other common treatments.”

July 19, 2019

U.S. must boost hospice oversight, watchdog warns, citing serious lapses

by Patrick A. Malone

Lawmakers and regulators must significantly improve the oversight of the burgeoning business of hospice care, a federal watchdog says. Its report came with two notable numbers: from 2012 through 2016, health inspectors cited 87% of the end-of-life care facilities for deficiencies, with 20% of them having lapses serious enough to endanger patients.

In one case cited by the Office of the Inspector General in the Department of Health and Human Services (HHS), a hospice patient had a deep, poorly treated pressure wound on the tailbone, apparent pain that caused grimacing and — in a crisis requiring a trip to the emergency room — a “maggot infestation’’ where a feeding tube entered his abdomen, the Washington Post reported.

July 18, 2019

Cutting resident doctors’ hours doesn’t harm quality of patient care, study finds

by Patrick A. Malone

Will the medical educators finally get that it makes no sense to force residents to toil like field animals? Yet another study, this latest from Harvard experts, finds that keeping residency training hours at more humane levels does not significantly affect quality of patient care, including inpatient mortality.

Let’s be clear: The grueling preparation for MDs is only relatively better than before, capping their training time to 80 hours a week.

Medical educators, hospitals, and doctors themselves have criticized that limit since it was imposed after long study and much argument in the profession by the Accreditation Council for Graduate Medical Education (ACGME), the group that accredits MD training programs.

July 16, 2019

Will GOP attack on Obamacare foil good plans to better kidney disease care?

by Patrick A. Malone

More than 37 million Americans who suffer from chronic kidney disease soon may see big changes in the way their disabling condition gets treated, potentially also reducing the $100 billion that the federal Medicare program pays for care of the body’s crucial blood cleaning organs.

President Trump issued an executive order calling on the federal government to use all means possible to attack kidney disease in three key ways:

Reduce the number of patients who suffer from kidney failure;

July 15, 2019

Taming Big Pharma profiteering is no snap, White House learns in dual defeats

by Patrick A. Malone

It takes more than a lot of huffing and puffing to blow down the ever-rising high costs of prescription drugs, the Trump administration has found. Two defeats happened last week: officials were forced to pull a plan to curb profit-making by drug industry middlemen, and a federal judge axed on First Amendment grounds a plan to muscle Big Pharma into including price information in its ubiquitous product ads.

These were key pillars of the president’s multi-part plan to address increasing drug costs, one of Americans’ most pressing concerns with their health care, and Trump had put considerable of his political capital behind them as he rolls toward the 2020 election campaign.

As the New York Times reported:

July 12, 2019

A harsh reminder of hospital infection risks: outbreaks in areas treating kids

by Patrick A. Malone

Parents and the public received grim reminders of the risks of medical care as prominent institutions on opposite coasts battled hospital-related infections among some of the most vulnerable patients around: babies and children.

In the Pacific Northwest, a mold outbreak has taken a terrible toll — with one patient dead, five others infected, 1,000 surgeries postponed and 3,000 people told to watch for infection symptoms — at Seattle Children’s Hospital, which the Washington Post reported, “consistently ranks as one of the best children’s hospitals in the country and this year [was] rated top [for such facilities] in the Northwest.”

In the Northeast, the University of Pittsburgh Medical Center Children’s Hospital has confirmed 12 cases of a drug-resistant staph infection in its neonatal intensive care unit (NICU), CNN reported, adding that, the six babies, including one who is potentially symptomatic, and six symptomatic employees who have tested positive for Methicillin-resistant Staphylococcus aureus (MRSA) are receiving treatment.