Archive for October, 2007

Desperate Patients: When Treatment is Too Expensive

October 29th, 2007 by Melanie Matthews

With all the emphasis on transparency in the healthcare industry, will we ever see a day when the pharma industry is held to the same reporting standard for pharmaceutical costs?

In this October 29, 2007 Newsweek article, Geraldine Ferraro describes how her ongoing battle with multiple myeloma has opened her eyes to the frailties of the U.S. healthcare system. The real eye-opener of the article, however, is the extreme lengths to which one sufferer must go in order to obtain treatment when the conventional path is too expensive:

Ferraro writes:

I routinely get calls from multiple-myeloma patients around the country. One conversation in particular sticks out: it was from a retired teacher in Montana who explained that he was feeling terribly fatigued. When I asked him about his hemoglobin levels (you get to know about this stuff when you have a blood cancer), they were startlingly low. “Oh, my God, they’re not giving you Procrit or Aranesp or one of the other anemia medicines?” I asked. “No. I can’t afford it. It costs $800 a shot,” he said. He explained that he’d had to devise a cheaper alternative to manage the anemia. “I wait until my hemoglobin gets down to seven [that’s really low] and then I go to the hospital and get a transfusion, which only costs $50,” he said.

In the same article, Ferraro laments the lack of transparency when it comes to pharmaceutical price:

It amazes me that in Italy, you can buy drugs for a fraction of what they cost here. Why? Because Italy and many other countries regulate the price of drugs. Yet here in the United States, consumers and insurers are subsidizing those cheap drugs by paying high prices to the pharmaceutical companies. That’s not fair.

Adolescent Behavior on an “Average Day”

October 29th, 2007 by Melanie Matthews

Today may be an average day, but see if your definition of “average” changes after reading this new data from the Substance Abuse and Mental Health Services Administration (SAMHSA), which found that on an average day in 2006:

  • Nearly 50,000 adolescents used inhalants;
  • Nearly 27,000 adolescents used hallucinogens;
  • Nearly 13,000 used cocaine;
  • Nearly 3,800 used heroin;
  • Nearly 8,000 adolescents ages 12 to 17 drank alcohol for the first time;
  • Approximately 4,300 adolescents used an illicit drug for the first time;
  • Around 4,000 adolescents smoked cigarettes for the first time;
  • Nearly 3,600 adolescents used marijuana for the first time; and
  • Approximately 2,500 adolescents abused pain relievers for the first time.

Overall, SAMHSA finds fewer adolescents are using illicit drugs than in 2002, but misuse of prescription drugs among adolescents increased from 5.4 percent in 2002 to 6.4 percent in 2006, largely attributable to the increase in nonmedical use of pain relievers. In this week’s Healthcare Business Weekly Update, read about a SAMHSA pilot to deliver point-of-sale substance abuse prevention information sheets to purchasers of highly abused prescription drugs, a first step in combating prescription drug misuse among teens and young adults.

It’s a bird, it’s a plane…no, it’s Super Bug!

October 26th, 2007 by Melanie Matthews

With the recent wave of MRSA staph infections on the nation’s front burner, super bugs are on the brain here in the US as well as overseas.

Curing Death blogs about some new ways the UK is fighting other super bugs in hospitals. The Bradford Infection Group (BIG), based within the University of Bradford’s Schools of Engineering, Design & Technology and Life Sciences, was awarded a grant that will be used to fund an investigation into alternative strategies for controlling hospital acquired infections.

“Approximately one in ten patients pick up an infection during a hospital stay. While hand washing and other hygiene measures are vital, evidence suggests that these measures alone are not always enough to prevent certain infections and therefore a fresh approach is needed,” said Clive Beggs, head of the Bradford Infection Group and professor of medical engineering at the University of Bradford.

Smoke Break: Employers Try to Wean Workforce from Smoking

October 26th, 2007 by Melanie Matthews

The New York Times highlights employers’ efforts to get workers to quit smoking. Employers are motivated by financial gain from reduced healthcare costs and an expected boost in productivity from healthier employee lifestyles.

Why Do Some Physicians Cling to Unhealthy Behaviors?

October 25th, 2007 by Melanie Matthews

Nick Jacobs at the World Health Care blog describes the unhealthy behavior of attendees at a world cardiology conference. Happily, the patient outcomes reported at the conference were positive.

My last four days were spent at a world conference on cardiology where the work done by our research institute’s cardiac team on the impact of behavioral modification on this disease was our presented topic. Our research revolves around diet, exercise, stress management and group support, and the results observed from our patients have been nothing less than remarkable.

It is fair to say, however, that, upon observing the actions and choices of those present my heart sank. The secret of life appeared to be firmly seated in the minds of at least 40 percent of those in attendance that tobacco, alcohol, heavy fats and little exercise are the keys to happiness.

…What then is the problem? Denial? The high pressure life styles of these life saving physicians, cultural considerations, a laissez faire attitude toward the Boogie Man or just another version of man’s on going stupidity and ignorance toward what appears to be very clear evidence?

I just don’t get it. I suppose that physicians are human, after all. The behavior described in this post may contribute to the low ratings many healthcare providers get for coaching patients to rid themselves of unhealthy behaviors. Nick’s experience is dismaying, especially after two experiences this week—one personal and one professional—that emphasized providers’ commitment to reducing the effects of heart disease.

First, my 73-year-old mother, who had a quadruple bypass five years ago, was hospitalized with chest pains. A catheritization determined that some additional blockage was the cause of her pain, and they are treating this with medication for now. Upon leaving her hospital room, I noticed a bulletin board devoted to discharge instructions. Every flyer on the board emphasized the danger of smoking for heart patients.

Secondly, in my professional life here, I am editing a book on Successful Management of Heart Failure Patients: Multidisciplinary Approach to Reducing CHF Readmissions, which chronicles the effort behind the dedicated heart failure unit at Hackensack University Medical Center in New Jersey, an exercise in pursuing perfect care. I am impressed by the dedication of the two cardiac nurses who head this effort. They have done similar work at other hospitals and are doing a phenomenal job at reducing hospital readmissions among this population.

When surrounded by evidence of the risk associated with these behaviors, wouldn’t providers make the obvious behavior choices? Or do they, like many adolescents, believe they are invincible?

Heart Health

October 25th, 2007 by Melanie Matthews

This week’s Disease Management Update focuses on healthy hearts and presents two possible techniques for maintaining heart health in your patients. Visit this blog entry to read (and hear) about two nurses from Hackensack University Medical Center who are pursuing perfect care with their award-winning heart failure team.

FDA Approves New Breast Cancer Treatment

October 25th, 2007 by Melanie Matthews

The U.S. Food and Drug Administration (FDA) recently approved Ixempra to be used in patients with metastatic breast cancer who have not responded to certain other cancer drugs.

The drug was approved to be used in combination with capecitabine, another cancer drug. It is to be used for patients who do not benefit from two other chemotherapy treatments—an anthracycline (such as doxorubicin or epirubicin) and a taxane (such as paclitaxel or docetaxel)—any longer. Ixempra was also approved for use in patients who no longer benefit from an anthracycline, a taxane and capecitabine, without being combined with capecitabine.

This approval is important because it provides certain patients with a new chemotherapy option in instances where other drugs have failed,” said Douglas C. Throckmorton, M.D., deputy director of the FDA’s Center for Drug Evaluation and Research. “FDA is working every day to support the development of safe and effective new therapies that benefit patients in need.”

Weight Gain Increases Risk of Breast Cancer

October 24th, 2007 by Melanie Matthews

According to a recent study featured in U.S. News & World Report, women who gain weight after the age of 18 increase their risk of breast cancer, compared to those who maintain a stable weight.

Women who were at or below a normal weight at age 18 but were overweight or obese at ages 35 and 50 had 1.4 times the risk of developing breast cancer, compared with women who had maintained a normal weight. Women who subsequently lost weight had the same cancer risk as those who maintained a stable weight.

Electronic Medical Records: The Promise of Voice Recognition Software

October 24th, 2007 by Melanie Matthews

A post on the The MedFriendly Blog emphasizes the importance of proofreading transcribed medical records:

The medical record is a crucial piece of information that when it is not proofread and is left with either incomplete or incorrect information, it diminishes the ability of other providers to fully understand the case. This is poor practice.

Dr. Joel Diamond
These observations by Dr. Dominic Carone reminded me of comments from Dr. Joel Diamond, who discussed the promise of voice recognition software during our recent Healthcare Trends and Forecasts in 2008 webinar. Dr. Diamond is chief medical officer, North America for dbMotion, Inc., a provider of medical informatics and an active partner at Diamond, Fera and Associates, a family medicine practice:

Anybody that is looking at EMRs will ask about voice recognition. A year ago or earlier, if you had asked me about voice recognition, I would have said that I was totally against it because voice recognition to date is really the same as transcription or writing. It amounts to free text in the medical record, and the problem with free text is that it’s worthless. There’s no way of getting that data out of the record when it’s free text; if it’s structured data, then we can do something with it — we could learn, do research, perform process improvement. One of the reasons I’ve come full circle on this is that free text allows physicians to work faster. Because of that, there is a higher adoption rate of EMRs. We’re in a race, and that is why we have to get as many doctors using EMRs as possible. If voice recognition allows us to do that, then that would be great.

Keep in mind, however, that as we look at voice recognition, we don’t want to sacrifice the future by trying to save some time today. If we can get physicians to use this technology in a meaningful way and get them to focus on the present illness or the assessment plan, then we could do well. Doctors ask me what to extract from these EMRs. There are several examples that I use. I know doctors that have an EMR, but tend to use free text or voice recognition to record their medicine lists or their problem lists.

A few years ago when the medication Vioxx ® was recalled, it was the first time in my professional life that I just went to the computer and typed in the word ‘Vioxx’ and got a printout with the name of every single patient for whom I had prescribed the drug. In fact, I saw several patients for whom I had never written a single prescription for Vioxx but had just handed out samples to those patients. This was an incredibly useful tool for notifying those patients and informing them of what had happened. Without an EMR, I probably would have waited until they came to see me because there would be no way of auditing those charts. Similarly, had I free-texted those charts, I probably wouldn’t have been able to get at it as well.

Pre-Paid Healthcare: Concierge Medicine for the Un- and Underinsured

October 22nd, 2007 by Melanie Matthews

Soon you may be choosing your healthcare plan the way you choose cell phone coverage: pre-paid vs. fee-for-service. The Wall Street Journal Health Blog reports that several hundred primary care physicians around the country are offering pre-paid plans for unlimited primary and urgent care, including office visits, lab work, X-rays and certain generic drugs. One West Virginia doctor charges $125 a month.

It’s not supposed to replace insurance — the deal doesn’t include any specialist or hospital care, and it doesn’t cover branded drugs or serious procedures. But for those without insurance, the pre-paid approach could represent an affordable stopgap.

Though still experimental, proponents argue that the pre-paid approach tackles two problems in U.S. health care: a decline in the number of primary care doctors and the growing number of Americans who are either uninsured or underinsured.