Heroes on the front line in Italy

Their eyes are tired. Their cheekbones rubbed raw from protective masks. They don’t smile.

The doctors and nurses on the front lines of the coronavirus pandemic in Italy are almost unrecognizable behind their masks, scrubs, gloves and hairnets — the flimsy battle armor donned at the start of each shift as the only barrier to contagion.

Associated Press photographers fanned out on Friday to photograph them during rare breaks from hospital intensive care units in the Lombardy region cities of Bergamo and Brescia, and in Rome. In each case, doctors, nurses and paramedics posed in front of forest green surgical drapes, the bland backdrop of their sterile wards.

Decades ago, I worked in an historic teaching hospital associated with a world-class university. It was appropriately one of the few U.S. hospitals with a section reserved for treatment of rare, usually-imported, deadly diseases. I don’t recall the official name. The grunts I worked with – charged with maintaining essential infrastructure – called it the “Plague Ward”.

I can still recall the eerie and scary feeling we shared – electricians, structural workers, line mechanics – when we suited up in what passed for hazmat suits back in the day, surgical masks, towels wrapped over our shoes…

That feeling is back.

Insurance companies drive physicians crazy – nearly half now prefer upgrading Obamacare to single-payer

❝ There are many reasons people put off going to the doctor. One of the big reasons is cost — a huge arc in the current debate about whether and how to repeal and replace Obamacare, which sought to increase the number of Americans with quality health insurance. Another is access, or finding a doctor who takes your insurance and has appointment openings. But whatever the reasons, the disconnect means that many people choose to become patients only in extreme circumstances and are then at the mercy of the system.

❝ “It really debases and demeans and takes away your dignity to be shuffled around when you know you have something wrong with you,” said Dr. Paredes, an obstetrician-gynecologist in Lakeland, Fla., who practiced in a variety of healthcare settings before retiring two and a half years ago. “I think healthcare is something that should be available to everyone from cradle to grave.”

That’s one of the main reasons nearly half of the 500 doctors who responded to a February LinkedIn survey said they would support a single-payer healthcare system, or Medicare-like coverage for everyone, not just the elderly, instead of the current patchwork model of insurance coverage.

Aside from the crap lies offered by Congressional Republicans…

❝ …For many physicians, the issue comes down to efficiency. In their responses, they cited the administrative hassle of working with multiple insurance companies, each with its own rules and billing procedures. And they pointed to some of the less visible costs, like patients who bounce from one healthcare provider to another as their health plans change.

A total of 48% of physicians said they would be in favor of single-payer healthcare, while 32% were opposed and 21% said they didn’t know.

❝ And even though doctors acknowledged that they might take a financial hit under a single-payer system, many respondents said it would be more than mitigated by getting out of the collection business. In other words, even if they earned less, there would be more patient care and less of the aggravation that comes with negotiating with and tracking down payment from multiple insurance companies.

RTFA for pretty middle-of-the-road analysis. For me, the truth has always been cost. Social Security and Medicare each are national insurance programs with premiums paid by the insured and, generally.their employers. There’s an artificial cap allowing high earners to stop paying the SSA tax at just over $100K income. Still, both of these systems are run with administrative costs less than 3%. And they work well. Helluva lot better than the motley arrangement Obamacare relies on.

Our adorable insurance companies declare their administrative costs run 14-25% and jack up all their rates accordingly. Couple that with a Congress that refuses civilians the same right the military has to negotiate fixed prices for prescriptive drugs – and we get screwed twice by the existing system. That’s the system Republicans and Blue Dog Democrats want to make more expensive and less safe for the insured.

Humbug!

Thanks, Barry Ritholtz


Clinical trials tend to be positive when Docs get industry dollar$

When study investigators have financial relationships with pharmaceutical companies, clinical trial results are more likely to turn up positive…

In a review of 190 papers on randomized controlled trials, taking money from industry was significantly associated with favorable trial results in a fully adjusted model…Salomeh Keyhani, MD, of the University of California San Francisco, and colleagues reported online…

Their findings suggest bias in the evidence base, Keyhani said. Practicing clinicians “should be concerned enough to employ healthy skepticism while reviewing the results of any one trial,” she told MedPage Today.

❝ The paper makes the distinction between a study being funded by a drug company, and investigators who have financial relationships with those companies.

Researchers with financial relationships can influence the study results in less obvious ways, such as study design and analytic approach, but Keyhani noted that the current research is a “cross-sectional study so any interpretation of the findings should be made with caution.”…

Gasp! Who’da thunk it.

RTFA for methodology – and more.

In opioid withdrawal – and no help in sight

A patient receives prescription opioids after an accident — and no support from his physicians as he weans himself off.

❝ No one will be surprised to hear that I was angry. Angry at myself, angry at my doctors, angry at the medical community. Just — angry. I had been hit by a van and undergone five surgeries, yet the worst part of the experience was my month in withdrawal hell. How could it be that my doctor’s best tapering advice led to that experience? And how could it be that not one of my more than ten doctors could help?

Sad, but, true. A tale worth reading. Worth understanding what happens in a nation where healthcare is considered privilege rather than right. How priorities are – and aren’t – established.

Thanks, Danny Blanchflower

The opioid painkiller and heroin epidemic – in one map/gif

The opioid painkiller and heroin epidemic led to a new record in drug overdose deaths in 2014 — more than 47,000 overdose deaths that year alone, and nearly two-thirds of them were linked to opioids and heroin.

But what does that death toll really look like? These maps, published by Socrata, contextualize how far and wide the opioid epidemic has spread, showing the rate of drug overdose deaths by county in 2004 and 2014…

As the maps show, it’s not just that overdose deaths rose as a result of the opioid crisis; these deaths also spread to all parts of the country. The deaths are, truly, an epidemic.

How did this happen? The short answer is that doctors believed what Pharmaceutical companies told them.

Big Pharma lied. RTFA.

Screwups by the Medical-Industrial Complex are the 3rd biggest cause of death in America

med:ind complex

Medical errors kill more people than car crashes or new disease outbreaks. They kill more people annually than breast cancer, AIDS, plane crashes, or drug overdoses. A new study estimates that they are the third leading cause of death in the United States, causing a quarter-million fatalities in 2013 alone.

Patient safety researchers Marty Makary and Michael Daniel published new data in the British Medical Journal Tuesday suggesting that preventable medical errors resulted in 251,454 deaths in 2013. If that estimate is correct, the only bigger causes of death are heart disease and cancer.

The researchers worry, however, that their number is actually an underestimate — that medical harm kills even more patients than we’re currently able to count

When a patient dies as a result of medical harm, there’s no regulator that has to get notified — the hospital doesn’t send off paperwork about the error that occurred. Sometimes the information gets jotted down in the patient’s medical record, but even that is not a certainty.

This makes estimating the frequency of medical harm very difficult — and researchers generally believe that their figures underestimate the prevalence of harm. Their study uses data from four recent studies, all of which relied on medical records to estimate fatalities caused by medical errors. So the authors know that their estimate of fatalities misses any errors that weren’t captured in the medical record…

Still, they argue that there is value to putting out the best number they can find, as it can draw attention to the potential magnitude of a rarely discussed problem in health care…

Some errors in medicine are stunningly bad….They are terrible and easy to recognize. But they aren’t what cause the most harm in American health care. It’s the less stunning, more quotidian mistakes that are the biggest killers. Take, for example, bed sores.

Bed sores are one of the more mundane complications of modern medicine. They’re called “pressure ulcers” in medical jargon, and are the open wounds that patients develop when they have not moved for long periods of time. The skin literally cracks under the pressure of the body weighing down on it.

A 2006 government survey found that more than half a million Americans are hospitalized annually for bed sores that are the result of other care they have received. And 58,000 of those patients die in the hospital during that admission.

Does this mean that pressure ulcers killed all those patients? No — these are typically frail, elderly patients battling other conditions ranging from pneumonia to dementia. But did bed sores mean some of these patients died who otherwise wouldn’t have? Experts say that’s almost certainly the case.

Like Congressional politics or the average conservative family values agenda – American health care is steadily devolving back towards the 19th Century. The ranks of sub-par management coupled with industrial-level greed is about as dangerous to the public good as populist politics shepherded by a media establishment with no backbone and fewer standards.

Zombies vs Vampires — legal battle between corrupt medical labs

Right now a dead, bankrupt and corrupt laboratory company is suing an active, morally bankrupt lab company. No matter who eventually wins the court battle all of us — patients, Medicare, insurance companies, not to mention our entire health and legal systems — will lose.

Health Diagnostics Laboratory is the zombie lab company. After raking in hundreds of millions of dollars in a few short years for its owners and others, HDL went out of business last year. The reason: the company’s business model was illegal and unethical.

The company bribed doctors to order unnecessary tests — lots of unnecessary tests. Then it told patients that they would not be billed for the tests. This is also illegal.

But in its heyday the company reaped hundreds of millions of dollars in payments from Medicare and insurance companies.

True Health Diagnostics is the vampire lab company. When HDL went out of business this new company bought its remaining assets and adopted its business model of bribing doctors to order their tests and not collecting the patients’ portion of the bill. (Despite the company’s denials, True Health appears to have close connections with at least some of the major figures involved with HDL.)

Late last year the surviving legal remnant of HDL began efforts to collect from patients on some of the bills on which the company had promised, in writing, never to collect…

Patients panicked when they suddenly found themselves faced with thousands of dollars in bills. Naturally many of them called their doctors to complain, and many of the doctors complained to their True Health sales reps, since in many cases this was the same person.

True Health in turn panicked. It threatened to sue HDL. If doctors and patients believed that there was even a small chance that patients would be held responsible for thousands of dollars for their tests then their entire sleazy business model would topple like a house of cards. So the company sent letters to doctors, telling the doctors to tell their patients to ignore the letters.

This did not sit well with HDL, which then sued True Health…

I have no idea how the legal issues here will be resolved. I don’t know if patients who were promised they would never receive a bill can be held responsible for those bills because those promises were illegal. This kind of situation is exactly why we have so many lawyers but so little justice.

But I do know this: the one thing missing in the battle of the zombie lab versus the vampire lab is justice.

The responsible figures — the HDL leaders, its salesmen, and, especially, the doctors who ordered and profited from all these unnecessary tests — are not being held responsible. Many of the same doctors and salesman who participated in the earlier HDL scheme are now participating in the True Health scheme…

We’ll probably never know how many hundreds of millions of dollars were made by the HDL executives and salesmen and the doctors who participated in their scheme. And unless people start going to jail there will be no incentive to stop more schemes like this. Civil suits, by the government or by private insurance companies, will simply be viewed as the cost of doing business.

Gotta love self-regulating, self-policing crafts, trades, industries. Seems to me a great deal of what is involved here is plain and simple fraud. Some of it must have crossed state lines. If states won’t act responsibly – well, that’s why we have federal attorneys.

243 medical “professionals” busted in $712 million Medicare fraud


Digitizing medical records tracks provider accounts as well as individual histories

The U.S. Justice Department charged 243 people, including 46 doctors, nurses and other medical professionals, with defrauding the Medicare system of $712 million through false billing.

Attorney General Loretta Lynch announced the charges…calling the case the largest sweep of individuals in the history of task forces that target such fraud.

“The defendants charged include doctors, patient recruiters, home health-care providers, pharmacy owners, and others,” Lynch said. “They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered.”

The defendants were accused of money laundering, conspiring to commit health-care fraud and violating anti-kickback laws. The scams involved treatments ranging from home health care to psychotherapy. The Justice Department alleged that participants in the scams submitted claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided…

Government efforts to combat health-care fraud led to the recovery of $3.3 billion in taxpayer dollars in the fiscal year that ended Sept. 30, according to a March report. During that period, U.S. prosecutors opened 924 new criminal health-care fraud investigations, the two departments said in the joint report.

The medical-industrial complex still hasn’t learned how to steal from taxpayers with the skill and cunning of their counterparts in the military-industrial complex.

Tub-thumping politicians in Congress blather day-in and day-out that they must oppose real single-payer healthcare because the people can’t be trusted to treat the system honestly. Yet, time and again, the real crooks turn out to be the practitioners, profiteering frauds within the medical community.

Are doctors ready for body cams?


Google Glass makes it into the surveillance society

Maybe you remember the famous video by Simons and Chabris. Two groups of students, one in white shirts and the other in black shirts, are passing a basketball around. You are asked to watch the video and count the number of passes made by one of the teams. You proudly count 13 (the actual number is 18). But what you didn’t notice, during all of your counting, was that midway through the video, a gorilla walked straight through the middle of the scene. Indeed about half of individuals tested in the original study missed the gorilla.

A red trauma victim is brought into the ED trauma bay by EMS. The lead paramedic provides details about the crash scene, the patient’s health status, and gives a point-by-point report about the prehospital care. Too bad that only 36% of the key information was accurately remembered by the receiving ED group.

What’s happening here?

These two examples highlight how medical care can be perceived differently, and maybe even contradicted, by doctors and patients. We aren’t aware of something we have missed — like the gorilla. You only see things you are focusing attention on. Have you ever had a patient complain “the doctor didn’t even examine my stomach” when you have performed, and documented, several serial exams? How many times have you been asked by a patient “When am I going to see the doctor?” when you’ve already had several conversations and introduced yourself as THE DOCTOR. Or, are perplexed by a family display of great disbelief when informed that their loved one is sliding towards the end of life.

We think we perceive and remember more of the world than we actually do, and different people experience the same inputs differently. We don’t see, hear, and remember alike. Hearing is passive, but listening requires concentration and focus to understand the meaning of another’s words.

Jeremy Brown has identified lots of examples where a med-cam can provide an objective view of medical reality — a sort of enhanced photojournalism — where the picture tells the truth. But we need to be ready to have our own behaviors and communications on display. After all, what’s good for the patient should be good for the doctor, too.

Questions of what’s private and what isn’t used to be decided essentially by what’s public and what isn’t. Starting with the obvious – like body cams for coppers – I can see where record-keeping is going. Not only for accurate answers to recurrent questions in an ER; but, the lawyers on retainer for the hospital are going to want this kind of recorded observation to keep a handle on liability.

The feeling changes. Your relationship with your employer changes. Doctors especially feel they’re part of the management team – even in large-economy-size urban hospital complexes. That feeling will change under observation. As much as useful qualities like those described in this article may be – in our society it’s easy to worry about office politics, petty jealousy becoming equally important to some administrator you consider to be an ignorant ass.