27 September 2013

In Medicine, More Is Not Always Better

What hospitals lobbied too hard to receive and prevent doctors in practice from receiving may have backfired on them. I say just deserts for your greed, hospitals. This New York Times article paints the correct picture. I can only call the tactics by hospitals as bullying tactics, not lobbying. What the Times article leaves out is the amount of money used to support congressional backers of the bill that favored the hospitals and now may need to be repeated. This of course will come out of the pockets of patients and taxpayers.

At least the Medicare Payment Advisory Commission is seeing the cost difference created by the hospitals with their “facility fee” addition to all submissions to CMS. This is done for hospital outpatient clinics that are part of the hospital and facilities where the hospital has established clinics by purchasing an entire physician practice.  A physician’s practice that is purchased by a hospital often stays in the same location and treats the same patients, but Medicare and Medicare beneficiaries pay more for the same services.

The 17-member Commission uses the following examples to show the disparities between hospitals and independent physician practices. An office visit for 15 minutes to an independent physician practice is reimbursed to the practice for $58 and the patient pays an additional $14.50 for a total of $72.50. The hospital receives $98.70 for the same consultation and the patient pays $24.68 for a total of $123.38 or a combined $50.88 more for the hospital.

Then consider a certain type of echocardiogram, Medicare and the beneficiary pay a total of $188 when this takes place in an independent physician practice. The same test done in the outpatient department of a hospital yields a total cost of $452. The hospital gains $264 over the physician practice. This hardly seems fair or justified for the patient.

The USA Today article says a study found that tens of thousands of times each year, patients undergo surgery they don't need. This calls for patients to be more vigilant when procedures are recommended involving surgery. Yes, the author blames doctors that are bad apples, but often I wonder why patients don't seek a second opinion.

Yes, patients have part of the responsibility for pushing doctors to take action for them or their loved one, when in fact, doing nothing or medically treating a condition may be the better course of action. Also, consider that the current medical system does provide incentives to perform a costly procedure instead of medical management.

As a patient, we need to learn not to be so trusting of our doctors and seek one or more opinions. The money you spend for that second opinion may just prevent you from bearing the total cost of surgery when Medicare or your insurance says it was not necessary and refuses payment.

26 September 2013

FDA Now Against Hyperbaric Oxygen Therapy

The FDA likes to be embroiled in controversy and they chose to do it quite regularly recently. This time they choose hyperbaric oxygen therapy. As is so often the case, what they don’t tell you is more important than what they do tell you. Yes, they are correct in issuing the warning as hyperbaric oxygen therapy (HBOT) has not been clinically proven to cure or be effective in the treatment of cancer, autism, or diabetes.

HBOT is approved to treat thirteen conditions: decompression sickness, thermal burns, non-healing wounds, necrotizing soft tissue infections (a.k.a. flesh-eating bacterial disease), acute traumatic ischemias (e.g., crush injury, compartment syndrome), radiation tissue damage, smoke inhalation and carbon monoxide poisoning, air or gas embolism, severe blood loss anemia, refractory osteomyelitis, compromised skin grafts, and clostridial myonecrosis (gangrene).”

What surprises me is the Department of Defense claims. They say that the will not use HBOT off-label because they claim that they don't prescribe off-label use of medications and treatments for veterans. If this were true, then the DoD needs to stop using off-label antipsychotic drugs to treat traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD).

In a study conducted in Israel, the use of HBOT helped TBI that had existed for many years and successfully. Yet the US DoD is rejecting this help for veterans. Where is our humanity? Oh, right, it is an off-label use. Yet licensed physicians and healthcare institutions may legally use an FDA-cleared hyperbaric chamber to treat unapproved or “off-label” diseases and conditions, though it is illegal to promote or advertise such uses. A few doctors are already using HBOT off-label, but not nearly enough of them.

Part of the warning says, “Patients may incorrectly believe that these devices have been proven safe and effective for uses not cleared by FDA, which may cause them to delay or forgo proven medical therapies.” I wonder which proven medical therapies they are talking about, dangerous drugs and expensive, invasive surgeries?

This is part of the problem. The FDA tends to protect therapies that are non-natural and patentable, so that drug companies can afford to spend $1 billion on average for agency approval. Bringing these drugs through the approval process pays the agency’s bills, including salaries. Indeed much of the cost of the FDA is born directly by drug companies, which creates a huge conflict of interest.” Bold is my emphasis.

The final bit of information the FDA did not mention in their warning is that the patents on HBOT ran out years ago. This means that this therapy will not garner additional use approvals because the FDA cannot require money for approval. HBOT is a dead issue as far as FDA is concerned and human suffering can continue.

Congress needs to step in and limit the funds FDA can require for approvals and put some other restrictions and orders in place to encourage better actions. Otherwise like HBOT, other projects such as diabetes test strip accuracy won't be acted on either.

25 September 2013

Home Care Coming Under Scrutiny

Who is checking on the people who are minding our elders? While this is taken from information gathered in California, I know that it applies to many other states. if not all states. According to a new policy brief and related report by the UCLA Center for Health PolicyResearch, very little data exists to measure the care or quality of care provided by private home care providers.

Two of the provider organizations in California, In-Home Supportive Services (IHSS) and Home Health Agencies are subject to licensing, certification, and background checks. The other two offer none of these protections and are Home Care Agencies and individual caregivers, whether they provide services of housekeeping or other non-medical support.

Nadereh Pourat, the UCLA center’s director of research and author of the study stated, “Regulations within the private home care industry might help establish standards for caregiving that can ensure patient safety and quality of care.” This combined with a mandatory background check should be a minimum. I don't think licensing should be required, but a form should be filed with the local law enforcement agency so that in case of a robbery, death, fire, or other accident, they could know who might have been in the residence.

Of course, the policy brief was funded by the Service Employee International Union, and the Union of Long Term Care Workers. They desire the licensing and union membership to put in their coffers.

Then those wanting regulation want them also for this reason. Regulation could result in another important benefit, creating public data that could be studied to better understand the quality of care provided by home care agencies. Regulations by the state to create standards of care and provide for background checks is understandable, but for other purposes such as providing curiosity data should not be the goal of regulations.

Other states would be wise to consider similar actions to create standards.

24 September 2013

Cause of Disappearing Honeybees

Whether the agriculture industry is actually pushing this or not remains to be seen, but I do know many farmers are and actively doing this. This being the spraying of insecticides on crops to kill insects. It is unfortunate that honeybees and other pollinators (a term that includes native bees, honeybees, birds, bats, and other species of beneficial insects) are being affected by the insecticides. I would be more inclined to believe that the agricultural chemical business in cooperation with some of the large agricultural industries is behind this killing of the honeybees.

Yes, and this would include the corn industry as they are ready to increase their profits in high-fructose corn syrup to take the place of honey.

Since 2006, up to 40% of the bee colonies in the US have suffered Colony Collapse Disorder (CCD), in which honeybees die, disoriented, far from their hives. The honeybee pollinates a third of all the food we eat and contributes an estimated $15 billion in annual agriculture revenue to the US economy alone. Fresh fruits and vegetables, in particular, would simply not exist without honeybees.

At least 143 million of the 442 million acres—that is, nearly one-third—of US cropland is planted with crops treated with these neuroactive insecticides, which are related to nicotine and are highly toxic to bees. In the US, 100% of corn and canola is treated with neonicotinoids, as well as 65% of soybeans and almost all cotton, wheat, and smaller acreage crops. The pesticide expresses itself through the plants’ pollen and nectar—the honeybee’s favorite sources of food.

A recent Time magazine article notes a number of potential reasons for CCD, including deadly bacteria and viruses—but nearly all researchers agree that the main culprits are general chemical exposure and pesticides (neonicotinoids in particular). A study of honeybee pollen found nine different pesticides and fungicides in it on average.”

The agriculture industry doesn’t want their profitable pesticides tampered with: there are over 1,200 pesticides currently in use in the US, and many are made by the same companies that engineer the crop seeds. So instead, Big Farma has begun creating CAFO-like conditions for bees! It’s already happening on a small scale; many argue that it may be the only alternative if we don’t reign in the pesticides. “Bees may end up managed like cattle, pigs and chicken, where we put them in confinement and bring the food to them,” said one beekeeper and independent researcher quoted in the Time article. “You…do feedlot beekeeping.””

Monsanto, surprise, is working on other GMO “fixes” for CCD as well: they’re developing RNA-interference technology that will kill one of the viruses thought to be killing the bees, the Varroa mite, by interfering with the way the bees’ genes are expressed.

Because I have a very soft spot for bees and have kept bees as I explained in my blog here, I would appreciate those living in the US to support a new bill, HR 2692, “The Saving America’s Pollinators Act of 2013,” that has been introduced in the House by Rep. John Conyers, Jr. (D-MI) and Rep. Earl Blumenauer (D-OR). It would suspend the use of neonicotinoids until the EPA can prove that the insecticide “will not cause unreasonable adverse effects on pollinators.” This proof of safety would need to be in the form of published scientific research together with a completed field study. Please contact your representative and urge his or her support of HR 2692.

23 September 2013

Doctors Are the People Spreading Infections

While I know a few doctors that will disagree with me, they are the ones that don't use hand or equipment sanitation, refuse to wear gloves, and in general ignore good safety standards. Some of these same doctors are the ones insisting on touching patients and giving them comfort according to them. I say comfort my !@@, I would rather know that the stethoscope has been sanitized and see them wearing gloves, than using an unsanitized stethoscope and not wearing gloves.

Another writer on the internet and a patient advocate agrees with me. About two weeks ago now, I received an email from a wife asking me if she had been wrong in insisting that the doctor wash his hands, wear gloves in examining her husband who was in the hospital with second degree burns over approximately 25% of his body and third degree burns on about 5 percent.

She stated that she had to wear a special gown and gloves when visiting her husband and she was aware of at least two other patients in adjacent rooms that had MRSA and did not want it spread to her husband. I emailed her back immediately and told her by all means and stand between her husband and the doctor until she knew that the doctor has sterilized his stethoscope, hands, and put gloves on. The next day I received another email saying that the doctor had refused to see her husband and had sent a nurse practitioner in while he remained out in the hall. She stated that the NP had washed her hands and gloved up before taking the stethoscope out of the sealed packaging and then examined her husband.

After they had finished rounds the NP had returned to thank her for correcting the doctor even though he refused to do any of what she had requested. The NP stated as she left that he had seen both MRSA patients before entering her husband's room.  That made the wife feel much more positive about what she had insisted on and she knew she would stand her ground until she was sure there were no more MRSA patients on that floor. A week later because of his improvement, he was transferred to another hospital and she was thankful because everyone there followed sanitation rules and had set the rules she was to watch for herself and other visitors.

Yet the author of the blog that got me wrapped up in this, does not like gloves and apparently other safety precautions and feels that human contact is essential. I am sorry Dr. Sibert, but I think I could not let you be my doctor or anesthesiologist in this case. Just stay out of the operating room if you are afraid of wearing gloves. To my way of thinking, you are the unclean person.