May 14th, 2011 by Mary Knudson in Opinion
Tags: Conflicts of Interest, Defibrillators, Doctors, Ethics, Heart, Heart Failure, ICD, ICDs, Industry, Medicine, Money, Patients
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I’ve been working for a couple of months on an in-depth article on personal defibrillators that are implanted beneath the skin of a person’s chest to shock a heart that starts shaking, thereby restoring its normal beating and preventing sudden death. Discussing these defibrillators is extremely complex, which is why I am spending so much time on researching and writing the article intended to help patients and their families make an informed decision by learning the truth about the devices known as implantable cardioverter defibrillators (ICDs) — the good and the bad, your life saved vs nothing happening or the accompanying risks and harm you may receive. So when I heard that a new study would be presented at the annual scientific meeting this week of the Heart Rhythm Society, a professional organization of cardiologists and electrophysiologists who use cardiac devices in their patients, I made sure to get an advance copy of what would be presented and interview the lead author.
Potentially such a study would be of interest to physicians and to patients considering getting an ICD because it looked at all shocks the defibrillators gave the heart in patients who took part in the clinical trial, including those sent for life-threatening rhythms and in error. For several reasons, I felt the study is not ready to report to the public. It is only an abstract. The full study has not yet been written, let alone published in a peer-reviewed journal or even accepted for publication. Patients with defibrillators who received shocks were matched to only one other patient who was not shocked, but the two patients were not matched for what other illnesses or poor quality of health they had. Yet they were matched to see who lived the longest and the study looked at death for all causes, not just heart-related. One critical question the study sought to answer was this: Do the shocks themselves cause a shortened life (even if they temporarily save it) or is a shortened life the result of the types of heart rhythms a person experiences? Read more »
*This blog post was originally published at HeartSense*
May 14th, 2011 by StevenWilkinsMPH in Health Tips, Opinion
Tags: Doctor-Patient Communication, Medication Errors, Medications, Non-compliance, Patient Experience, Pharmaceuticals
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Lots of smart people over the years have been trying to figure out why people stop taking their medications within the first 12 months. Within the first 12-months of starting a new prescription, patient compliance rates drop to less than 50%. This rate is even lower for people with multiple chronic conditions taking one or more prescription medications.
If these medications are so important to patients, why do they just stop taking them? It defies common sense. Sure issues like medication cost, forgetfulness, lack of symptoms, and psychosocial issues like depression play a role in patient non-compliance. But there also something else going on…or in this case not going on.
The problem is that doctors and patients simply don’t talk much about new medications once prescribed. Here’s what I mean. Let’s say that at a routine check-up a physician tells a patient that he/she wants to put them on a medication to help them control their cholesterol. The doctor spends about 50 seconds telling the patient about the medication. The patient nods their head takes the prescription and boom…the visit is over. Read more »
*This blog post was originally published at Mind The Gap*
May 13th, 2011 by John Di Saia, M.D. in Opinion
Tags: Boob Job, Botched, Breast Implants, Lawsuit, Malpractice, Perils, Plastic Surgery, Second Opinion
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A mother called the office today. Her daughter had breast implants placed by a surgeon in another state and the two ladies are not happy. They called for a second opinion.
It is dicey dealing with situation like this as a second opinion consultant. The first question is whether or not the first surgeon did anything wrong. A botched boob job is not any boob job that the patient or mother do not like. “Botched” indicates fault. Sometimes there is fault on the part of the surgeon and sometimes there is not. Sometimes patients ask for surgery on the cheap and decline breast lifting or other associated surgery that might have made things look better. Sometimes the patient choose a surgeon of limited skill or qualifications. Sometimes infection, cigarette smoking or scarring can distort an otherwise good procedure. It is not always clear.
The second question for a consultant is whether or not the patient wants him or her to fix things or just wants to return to the original surgeon. No smart consultant wants to end up embroiled in a patient’s lawsuit with the original doctor. It is a waste of time and time is money.
*This blog post was originally published at Truth in Cosmetic Surgery*
May 12th, 2011 by John Mandrola, M.D. in Health Policy, Opinion
Tags: Cardiac Electrophysiology, Cardiology, Devices, Experts, Health Care Reform, Heart Rhythm Society, Industry Ties, Johnson & Johnson, Key Opinion Leaders, Largesse, Manufacturers, Medical Devices, Transparency, USA Today
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Largesse: (Form thefreedictionary.com):
1. a. Liberality in bestowing gifts, especially in a lofty or condescending manner.
b. Money or gifts bestowed.
2. Generosity of spirit or attitude.
Two days into last week’s Heart Rhythm Society meeting, Propublica, an independent online investigative journalism-in-the-public-interest endeavor published a series of high profile articles as part of their Dollars for Docs series. Their marquee piece, published prominently in the USA Today, chronicled the strong financial ties (the ‘largesse’) that bind medical societies to industry. Reporters Charlie Ornstein and Tracy Weber highlighted the meeting’s ‘mansion’-sized exhibits, intense advertising, and the fact that most of the opinion leaders, officers of medical societies and guideline writers, the experts, have financial ties with medical device companies. More than half of HRS’ revenues came from industry.
Well.
I’ll offer four simple thoughts about all this conflict:
1. Nothing about industry influence at medical meetings is new news. I have been attending medical meetings for nearly twenty years, and industry has always been there. And here’s something you don’t read much about: it was far worse then. That’s all I will say about that. I won’t tell you how cool it was seeing the Charlie Daniels Band play at a medical meeting for free.
You can quibble with the extent of these current-day “cozy” relationships, or the glitz of exhibits at our gatherings, but you should also know that there is progress. The show is now out in the open. There is infinitely more disclosure. Smart people are now watching, tweeting, and reporting. Any doctor who’s been around more than a few years will agree that things have grown increasing more transparent. Which I believe is an improvement. Read more »
*This blog post was originally published at Dr John M*
May 11th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
Tags: Accountable Care Organizations, ACOs, Costs, fail, Healthcare reform, Hospitals, Savings
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In an ideal world ACOs should work. There is no evidence that untested and complex organizational structure of ACOs developed by Dr. Don Berwick (head of CMS) will improve quality of care and reduce costs.
ACOs are supposed to provide financial incentives to health care organizations to reduce costs and improve quality. There are too many defects in the ACOs infrastructure to improve the financial and medical outcomes.
At a conceptual level, the incentive for ACOs would be to increase efficiency and avoid overuse and duplication of services, resources, and facilities. In this model, ACO members would share the savings resulting from the increased coordination of care.
I have said over and over again that excessive administrative fees and ineffective management of chronic disease is the main source of waste in the healthcare system. ACOs do not deal with these main drivers of costs.
The only stakeholders who can demand that this waste be eliminated are consumers/patients. Patients must control their healthcare dollars. They will make sure there are competitive prices and will not permit duplication of services. Read more »
*This blog post was originally published at Repairing the Healthcare System*
