A Little-Known Provision in Reform Legislation: Safety Net for Alzheimer’s Patients and Others Who Need Long Term Care

Last week, the New York Times asked me to write an opinion piece for its “Room for Debate” section.

Here is the topic that the Times asked participants to discuss:

“An article in the Times this week focuses on a 5,000-member clan in Colombia that has an unusually high incidence of early-onset Alzheimer’s disease. A medical study of this large family, which lives in one Andes region, is being planned to see if giving treatment before dementia starts can lead to preventing the disease. In that traditional society, the heavy burden of caring for the ill falls on siblings, spouses, children and other family members.

Medication and Kids: A Growth Industry

Children have become the new growth industry for prescription drug makers. A study released last month by the pharmacy benefit manager Medco found that 26% of kids under 19—almost 30% of those aged 10 to 19—are now taking prescription medications for a chronic condition. Meanwhile, spending on prescription drugs for children increased by almost 11% last year, the largest increase experienced by all segments of the market, including the elderly. Although asthma drugs are the still the most commonly prescribed therapeutics, kids are increasingly being prescribed drugs that are decidedly uncommon for such young patients: atypical anti-psychotics, diabetes drugs, anti-hypertensives, cholesterol medications and heartburn drugs—expensive therapeutics that in the past were rarely used outside of adult populations.

The Medco figures are alarming first of all because intuitively it just feels wrong that so many children are downing prescription pills along with their morning multivitamin and orange juice. Kids are supposed to be healthy, full of energy, free spirited. But increasingly, this is not the case. More than 17% of adolescents (10-19 year olds) are now classified as obese: in fact, a whopping one out of three kids is considered overweight or obese. And obesity brings with it a raft of formerly adult chronic conditions.  According to a fact sheet provided by the Institute of Medicine, in one population-based sample some 60% of obese children aged 5 to 10 years had at least one cardiovascular disease risk factor—including high levels of total cholesterol, triglycerides, insulin, or high blood pressure—and 25 percent had two or more of these risk factors.

When Residents Are Not Supervised—Part 2

When Lewis Blackman, a healthy, gifted 15-year-old, underwent elective surgery at the Medical University of South Carolina-- one of the state's most modern hospitals--he was in good health. Over the next four days, he bled to death.
 

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Lewis Blackman’s mother, Helen Haskell, founder of Mothers against Medical Error, sent me this article, first published in The State (Columbia, South Carolina). Her story serves as an extreme example of the dangers that hospital patients can encounter when residents are working without more experienced doctors supervising them. I’m posting the story and commenting on it  [in brackets] because too often, patients suffer when residents are working without a net.

Yet Another Source Distressed By How the NYT’s Presented Its Data In A Story About the Dartmouth Research -- Part 2

Yesterday, I commented on a New York Times story that appeared Wednesday, June 2, attacking the Dartmouth Research.  The work that Dartmouth has done over the past two decades suggests that hospitals in some parts of the country are over-treating patients. Overtreatment means that patients who didn’t need to be in the hospital in the first place are exposed to the side effects of treatment as well as gruesome hospital- acquired infections, medication mix-ups and a host of other medical errors. Thus unnecessary care puts patients at risk while helping to drive health care bills heavenward--- and suggests that we could rein in Medicare spending by squeezing some of that hazardous waste out of the system.  But according to the Times: “Data [from Dartmouth] Used to Justify Health Savings Effort is Sometimes Shaky.”

In Part 1 of this post I discussed what two of the Times’ sources told me about how the Times’ reporters misrepresented what they said. Both Harvard economist David Cutler and Yale’s Dr. Harlan M. Krumholz complained that the story made it seem that they are critics of the research, when in fact they agree with Dartmouth on the basic message of the data, and see the work as, in Krumholz’ words “pivotal to moving us forward  . . . we all agree that there is lots of waste and it is unevenly distributed across the country.”

The New York Times Attacks the Dartmouth Research Part 1

Today, the New York Times published a piece about the Dartmouth research that is raising eyebrows-- in part because there are so many factual mistakes in the story, in part because the tone is so personal.

“It sounds as if it were written by someone’s ex-spouse,” a source who is very familiar with Dartmouth’s work told me in a phone conversation earlier today.

“Harris and Abelson were determined to write a story that would ‘take down Dartmouth,’”  confides a second source in Washington who spoke with the Times reporters.

This is the second critical piece that Times’ reporter Gardiner Harris has written about Dartmouth’s highly-respected work in just four months. I wrote about the first story here noting  that the article “garbled the facts” about the research, and quoted Dr. Elliott Fisher, the senior researcher, out of context.

Others quoted in today’s story indicate that the Times’ piece distorted what they said: “Every word is clearly accurate, but the implication is wrong,” says David Cutler, a Harvard economist health care policy expert who has advised President Obama on healthcare.

Dr. Harlan M. Krumholz, a professor of medicine and health policy expert at Yale also was quoted as if he doubted the basic thrust of Dartmouth’s work. The Times’ reporters  used  just one line  from his interview:  “It may be that some places that are spending more are actually getting better results.”

Today, Krumholz explained: “What I spent most of the interview trying to convey is that a lot of the back and forth [about bits and pieces of Dartmouth’s data ] is inside baseball stuff – and we are all working hard to figure out how to gauge costs and value better . But Dartmouth’s work on variation is pivotal to moving us forward – and we all agree that there is lots of waste and it is unevenly distributed across the country.

A New Survey Reveals What Most Hospitals Patients Don’t Know About the Residents Who Care For Them-- Part 1

Summary: Most hospital patients have no idea that the resident treating them could be coming to the end of a 30-hour shift. If he is exhausted, the resident’s judgment may be impaired. Yesterday, the union that represents some 13,000  residents and interns nationwide (CIRSEIU),  the American Medical Student Association (AMSA)  Public Citizen, the consumer advocacy organization based in Washington DC, , as well as sleep scientists at the Harvard Medical School’s Division of Sleep, announced the results of survey published in BMC Medicine, revealing how little the public knows about residents’ hours. 

Sleep deprivation is likely to lead to errors; residents themselves acknowledge that lack of sleep has caused them to make mistakes that harm, and sometimes even kill patients.  Exhaustion also affects how they feel about their patients.In 2008, the Institute of Medicine (IOM) recommended capping shifts at 16 hours, saying that longer shifts are unsafe for patients and residents themselves. The Accreditation Council on Graduate Medical Education (ACGME), the group that oversees the training of physicians in the U.S currently allows resident physicians to work for 30 consecutive hours up to twice per week.  The ACGME has been reviewing the IOM recommendations and is expected to announce its decision later this month.

The problem: residents represent cheap labor. Some say that the ACGME faces an inherent conflict of interest because its board is dominated by the trade associations for hospitals, doctors and medical schools that benefit from the residents’ long hours. Is this true?

A Salute to the VA on Memorial Day—Part 1

In 2007, a book by Phillip Longman sent lasting ripples through the U.S. health care establishment. The title was audacious: Best Care Anywhere. But it was the subtitle that shocked: Why VA Healthcare is Better than Yours.

Was Longman suggesting that the Veterans’ Health Administration provides better care than the treatment that millions of well-insured Americans typically receive in the private sector?  Yes.

Longman had uncovered what one reviewer called “the biggest untold story of the past decade,” the quality revolution that Dr. Ken Kizer launched when he took over the VA health system in 1994. And Longman had eye-popping evidence to back up his claims: overwhelming hard-core data from the most prestigious peer-reviewed medical journals. The research revealed that when it comes to everything from outcomes to patient satisfaction, and patient safety, the VA outperforms.