Primary Care

February 1, 2019

Motoring madness is taking its toll on Americans in an array of ways

If they didn’t create enough havoc already with the deaths and injuries they cause on the nation’s roads, Americans’ cars, trucks, and motorcycles also create other big consternations, including harmful commuting stress, rising pedestrian carnage, and tough calls about when seniors ought to be forced to give up driving.

Just how soon will it be before computers, robots, and autonomous vehicles ride to our rescue? Maybe not fast enough.

Too many motorists, especially in urban centers, may see their heads and bodies blow up — in figurative fashion — due to the daily strains of trying to navigate traffic gridlock, reported Austin Frakt, director of the Partnered Evidence-Based Policy Resource Center at the V.A. Boston Healthcare System, associate professor with Boston University’s School of Public Health, and adjunct associate professor with the Harvard T.H. Chan School of Public Health. He wrote in the New York Times’ research- and evidence-based “Upshot” column that Americans spend 42 hours annually stuck in rush-hour jams, and traffic’s toll for lost time and wasted fuel exceeds $100 billion.

January 31, 2019

Doctors ordering wasteful and excessive MRI and CT scans, experts say

by Patrick A. Malone

When patients experience bad headaches, severe chest pain, back or neck aches, or even when kids come in with gut pain that likely is appendicitis, doctors too readily push them into and through what may be hospitals’ over-sized cash-generating machines. It’s past time to end wasteful use of high-powered imaging systems, experts from the Mayo Clinic and Stanford University say.

Drs. Ohad Oren, Electron Kebebew, and John Ioannidis have called out their medical colleagues in an opinion piece published in the medical journal JAMA over excess computed tomography (CT) and magnetic resonance imaging (MRI), saying conditions can’t justify why Americans undergo these costly scans at many times the rate, for example, that Finns do.

Research shows diagnoses don’t improve with many more MRIs and CTs. Instead, they may lead to yet more costly, invasive, and unnecessary tests and procedures, some of which can harm patients.

January 29, 2019

OK, you’re sick and hurting. Can’t we still hit you up about donating to our hospital?

by Patrick A. Malone

Already-admitted patients shouldn’t be flummoxed if they’re moved into a bigger, quieter, and nicer room. There, a fluffy complimentary robe may await them. They may receive a warm welcome from well-attired executives — those senior enough so their pictures may even hang in pictures on the hall walls. And, yes, make no mistake, their nurses and doctors really will be kind and attentive.

Welcome to high-roller care as it’s delivered now to a select few by staff in at least three score big hospitals and academic medical centers nationwide, including Johns Hopkins and MedStar Health in Columbia, Md.

You won’t necessarily seek out or request this special attention. It turns out that hospitals will know you’re posh enough to merit it because loopholes in privacy laws allow them, using special software, to run regular searches through patient rosters to determine which guests also might be potential and lucrative donors, reported the independent, nonprofit Kaiser Health News service in a story that appeared in the New York Times. You also may allow the pitches because, likely unbeknownst to you, you signed a form giving your permission for it in that mountain of admission paperwork.

January 28, 2019

For too many women, an unending and painful tangle with surgical mesh

by Patrick A. Malone

Tens of thousands of women complain that a surgery to implant mesh to bolster weak abdominal tissue, instead has inflicted on them incontinence, chronic pelvic pain as well as pains in the groin, hip, and leg, and with intercourse. Others say they suffer complications as if they had the immune system attacking disease lupus, leaving them with persistent runny noses, muscle pain, fogginess, and lethargy.

The federal Food and Drug Administration in mid-February will convene its expert panel on women’s reproductive surgeries to see advice on next steps in what has become a legal and medical morass over transvaginal mesh operations.

As many as 4 million women globally have undergone mesh surgeries to treat urinary incontinence and weakening of walls in the abdominal area that causes prolapses, the Washington Post reported, quoting a UCLA reconstructive expert as estimating that 5 percent — or 150,000 to 200,000 — of those patients have experienced complications.

January 25, 2019

What’s prodding contact sports’ big shifts on head trauma? Insurance companies’ ‘panic’

by Patrick A. Malone

Parents and young athletes may have wrestled with the decision whether to play contact sports, as research shows the injuries that players can suffer from blows to the head. But lesser known parties to the games may be the undoing of professional and organized soccer, hockey, and football: Insurance companies.

The firms, which provide necessary and invaluable protections to players and organizations by spreading the financial risks of harms, have fled professional and amateur sports, declining to offer them coverages, even at high costs, Steve Fainaru and Mark Fainaru-Wada of ESPN’s Outside the Lines program reported.

Insurers are balking not only at providing liability policies but also worker compensation for pros, ESPN says. The dearth of coverage has hit hard the NFL, collegiate and Pop Warner programs, as well as football helmet makers. They’re forced to hunt far and wide for the few firms willing to assume sports risks — and they pay high and accordingly, if they can get policies.

January 24, 2019

Savvy Rx from a resident: Docs, know why and what you’re ordering, please

by Patrick A. Malone

Well, just because.

That isn’t a great answer for cranky toddlers with too many questions. It’s also an unacceptable but real reason why too many hospitalized patients get woken up in the middle of the night and subjected 24/7 to expensive, invasive, and often unnecessary tests and procedures.

Abraar Karan (right), an internal medicine resident at the Brigham and Women’s Hospital/ Harvard Medical School, has blogged with welcome candor about doctors’ casual acceptance of medical routines that not only discomfit but also can harm patients. As he wrote online for BMJ (aka the British Medical Journal): “The reality of medicine is that there are many things we as doctors do for absolutely no reason. That is to say, there is no evidence (randomized controlled trial or otherwise) for doing them, other than ‘that’s the way we’ve always done it.’”

January 22, 2019

Diabetes is serious. So why aren’t patients getting more treatment help?

by Patrick A. Malone

Doctors, hospitals, health officials, and disease advocacy groups race to warn about diabetes’ risks, harms, and increasing prevalence. But why, then, doesn’t modern medicine also do much more to help diabetics with the skyrocketing costs of their care, whether with insulin at excessive prices or with expensive medical aids?

Ted Alcorn of the New York Times drilled down on one slice of diabetes care to capture how medical profiteering distorts what ought to be a more direct, simple, and less pricey treatment for a disease that afflicts as many as 100 million Americans in varying degree.

He reported on the “strange marketplace” for the chemical-imbued plastic strips diabetics use to test their blood sugar, inserting them into specialized meters for glucose readings. Before diabetics adjust their diet or take insulin, they may test themselves with strips and meters as many as 10 times a day. The costs add up. Diabetics can pay thousands of dollars annually to get test strips over the counter.

January 21, 2019

Rich family played big role in opioid crisis, court records show

by Patrick A. Malone

A plutocratic clan that has labored to portray itself as enlightened patrons of the arts, science, and medicine, instead has been depicted in new court documents as drug profiteers, eager to exploit the misery and even deaths of tens of thousands of Americans.

The stories in the New York Times, Wall Street Journal, Washington Post, and at the online medical science news site Stat paint a damning picture of the Sackler family and their avarice with the family-owned Big Pharma firm Purdue. The company made the clan billions of dollars but also has become the focus of news stories, official investigations, and now a barrage of lawsuits, all asserting that Purdue played a crucial role in fomenting the nation’s opioid drug crisis.

The Sacklers had sought to distance themselves from the horrors unleashed by powerful opioid painkillers, including their company’s top-selling drug OxyContin. The opioid crisis last year alone claimed 70,000 lives, and the prescription and illicit painkillers of their ilk have become a leading cause of death for Americans younger than 50. Overdoses now savage white men, especially in ex-urban and rural areas; women 30 and older; blacks in big cities; and even children.

January 18, 2019

Pot harmless? No, and pro-con arguments over marijuana are ablaze, again

by Patrick A. Malone

Moderation matters with health issues, so skepticism about marijuana and its widening use may be welcome. But let’s see how much of recent wariness about this intoxicant is just a puff of smoke — or does it catch fire and become something more?

Author Alex Berenson has become the latest advocate for tamping down the national exuberance for pot. It has in recent days become legal for recreational use in 10 states and the District of Columbia and has been broadly legalized for medical purposes in 19 other states. Cannabis products have become trendy, and stocks in pot-selling enterprises have become a hot investment topic.

But Berenson — in Opinion pieces in both the Wall Street Journal and the New York Times, as well as in a new, well-selling book — paints a more ominous picture of weed. He’s not harkening back to risible scare campaigns, ala the movie classic Reefer Madness. Berenson says his concern about dope started in a casual mention by his wife, a psychiatrist, that the criminal patients she specializes in treating shared a commonality: They all smoked grass.

January 16, 2019

Obesity and poverty may stall 25-year decline in cancer deaths, experts warn

by Patrick A. Malone

Cancer hasn’t gotten knocked out of its spot as Americans’ No. 2 killer, but health officials have delivered some good news about the disease that once was considered irreversible in its lethal course: Cancer deaths rates have fallen now for a quarter of a century.

The American Cancer Society, pointing to 1991 as a peak year, says that death rates from the disease declined by 27 percent, “meaning more than 2.6 million deaths [were] avoided between 1991 and 2016.”

Still, 1.7 million Americans likely will be diagnosed with cancer this year, and the disease will kill more than 600,000 patients — meaning 1,666 people per day in this country will die of cancer.