Primary Care

November 24, 2019

On vaping, gun violence, and health insurance, the big talk flows, but action, not so much

When it comes to key health concerns of the American public, President Trump and his administration have offered evidence anew that whatever they say may not last to the next political moment, that inaction is its own powerful kind of action, and that what officials say they’re doing may be exactly the opposite.

This is not intended as partisan commentary. It reflects the turn of a few news cycles and how Trump and his officials have dealt with:

The outbreak of serious lung illnesses and deaths tied to vaping

November 22, 2019

For safety’s sake: Pedestrians, put down the phone! Bikers, put on the helmet!

by Patrick A. Malone

With the pedestrian death toll climbing to scary levels and bike-vehicle accidents zooming up too, individuals may need to take common sense steps to safeguard themselves and not rely on motorists or traffic planners for their safety.

Just as drivers need to put away electronic devices while they’re on the road, so, too, should folks on foot give up risky texting or online browsing on their smart phones while walking, experts say. And, though they may not be keen on them, helmets offer bikers important protections and they should be donned by riders regularly.

And if you’re zipping around on a scooter, your head is even more vulnerable than if you’re on a bike.

November 20, 2019

U.S. orders price postings in hopes of curbing hospitals’ trillion-dollar costs

by Patrick A. Malone

Tthe Trump Administration deserves credit for doing something right on hospital prices — but with what likely will be ineffective results.

The president and Alex Azar, the head of the sprawling Health and Human Services agency, have rolled out delayed new federal rules that will order hospitals, starting in 2021, to make public the discounted prices they negotiate with insurance companies and require insurers to allow patients to get advance estimates of their out-of-pocket costs before they see a doctor or go to the hospital.

Trump explained why, as reported by the New York Times, saying: “For decades, hospitals, insurance companies, lobbyists and special interests have hidden prices from consumers, so they could drive up costs for you, and you had no idea what was happening. You’d get bills that were unbelievable, and you’d have no idea why.”

November 19, 2019

Superbugs’ deadly rise has plunged planet into risky ‘post-antibiotic’ era

by Patrick A. Malone

Federal officials have put out some scary new findings about the state of patients’ health in the 21st century: Superbugs may be more common and potent than previously believed. And we may now have plummeted into what experts are calling the perilous “post-antibiotic age.”

This all amounts to far more than a hypothetical menace. It could affect you if you get, for instance, a urinary tract infection. Or if you undergo a surgery, say, for a joint replacement or a C-section. Depending where and how you live, you may see the significance of this health problem if you contract tuberculosis or some sexually transmitted diseases.

As the news website Vox reported of the startling new information from the federal Centers for Disease Control and Prevention: “Every 15 minutes, one person in the U.S. dies because of an infection that antibiotics can no longer treat effectively.”

November 17, 2019

Drugs are better for heart patients than surgery (except in mid-heart attack), study finds

by Patrick A. Malone

Tens of thousands of patients with serious but stable heart disease soon may see themselves treated more with prescription drugs and less with rushed surgeries, especially bypass procedures or operations that seek to open clogged blood vessels with wire cages called stents.

A possible shift away from stents — which have come under question for some time now — may be accelerated by the just-announced findings of a $100 million, multi-year study of more than 5,000 heart patients at 320 sites and in 37 countries. The research, the New York Times reported, sought to provide rigorous and more incontrovertible evidence on procedures that now are a bulwark of heart care:

“[The study dubbed] Ischemia is the largest trial to address the effect of opening blocked arteries in non-emergency situations and the first to include today’s powerful drug regimens, which doctors refer to as medical therapy. All the patients had moderate to severe blockages in coronary arteries. Most had some history of chest pain, although one in three had no chest pain in the month before enrollment in the study. One in five experienced chest pain at least once a week. All participants were regularly counseled to adhere to medical therapy. Depending on the patient’s condition, the therapy variously included high doses of statins and other cholesterol-lowering drugs, blood pressure medications, aspirin and, for those with heart damage, a drug to slow the heart rate. Those who got stents also took powerful anti-clotting drugs for six months to a year. Patients were randomly assigned to have medical therapy alone or an intervention and medical therapy. Of those in the intervention group, three-quarters received stents; the others received bypass surgery. The number of deaths among those who had stents or bypass was 145, compared to 144 among the patients who received medication alone. The number of patients who had heart attacks was 276 in the stent and bypass group, compared with 314 in the medication group, an insignificant difference.”

November 15, 2019

13 million and one reasons why simultaneous operations should be barred

by Patrick A. Malone

A big Boston hospital has offered 13 million and one ways to try to make good with a former orthopedic surgeon who assailed the respected institution and colleagues for performing simultaneous operations in which doctors went from suite to suite, working for hours on multiple patients at once.

Massachusetts General Hospital insisted this practice was safe. Dr. Dennis Burke, a hip and knee specialist whose patients have included former Secretary of State John Kerry, disagreed. He told his bosses at the Harvard-affiliated hospital that simultaneous procedures put patients at risk, and, at minimum, they should be told that the surgeons they flocked to for surgery on them might pop in and out of their procedures.

Burke infuriated his bosses by taking his criticisms outside the hospital, including to investigative reporters for the Boston Globe. The newspaper dug into hospital surgeries, particularly in orthopedic cases where operations lasted for hours.

November 13, 2019

Big Pharma under fire over quality, safety, and patents on costly brand drugs

by Patrick A. Malone

When Big Pharma insists its sky-high prices are justified, patients may want to keep in mind key findings just revealed about prescription drugs and their makers:

Expensive brands may not be manufactured by name firms, and instead, may be cranked out in dirty and risky secondary facilities. And the research that leads to expensive products may have been ripped off from federal scientists funded by taxpayers who aren’t getting paid back.

Sydney Lupkin of the independent, nonpartisan Kaiser Health News service deserves credit for expanding public attention on growing concerns over the safety and quality in drug manufacturing beyond generics and on to costly, blue chip branded prescription medications. As she reported of the Federal Food and Drug Administration:

November 12, 2019

New doubts cast on a key safety tool: police roadside alcohol-testing devices

by Patrick A. Malone

Although drunk drivers inflict terrible carnage on others traveling on the nation’s streets and highways, law enforcement agencies and skeevy device makers may be unwinding the trust in what has become a cornerstone of the nation’s safety regimes: roadside alcohol testing machines.

The New York Times reported that it “interviewed more than 100 lawyers, scientists, executives and police officers and reviewed tens of thousands of pages of court records, corporate filings, confidential emails and contracts” to discover “the depth of a nationwide problem that has attracted only sporadic attention.”

As the newspaper noted of roadside “breathalyzer” exams and devices used for them:

November 10, 2019

Hospital tries to stick ER nurse with $1 million in debt for her preemie’s care

by Patrick A. Malone

It’s the price and cost problem, stupid. That’s a fictitious but new tattoo that voters might want politicians to take up as they consider the many major problems with the American health care system, especially as yet more medical billing outrages surface.

Marshall Allen, a reporter for ProPublica, the Pulitzer Prize-winning investigative site, posted about a doozy: It’s about almost $1 million in charges that a hospital group sought to saddle a new mom with, even as she wrestled with pregnancy complications and an ailing premature baby.

That mom also happened to be an emergency room nurse. And the chain that flubbed her medical bill was her own employer: Dignity hospitals. That’s a Christian medical enterprise that describes itself as the fifth largest health system in the nation and has as its motto, “Hello, human kindness.” As Allen reported, it’s worth noting this, too, about Dignity:

November 7, 2019

‘Any One of Us’ shows harsh realities and hope for spinal cord injury patients

by Patrick A. Malone

Extreme sports may be to blame. Or it might be a falling tree, an error with a surgery, or an auto wreck.

As the title of the tough, direct, and new HBO documentary makes clear, “Any One of Us” might suffer from a calamitous spinal cord injury (SCI). The 1-hour and 25-minute work by first-time director Fernando Villena focuses on pro mountain biker Paul Basagoitia but is carried by a “chorus” of 17 women and men who all have had significant injuries to their spinal cords.