Monday, February 12, 2018

A Perfect Storm for Broken Bones - The New York Times

A "perfect storm" threatens to derail the progress that has been made in protecting the bone health of Americans. As the population over 50 swells, fewer adults at risk of advanced bone loss and fractures are undergoing tests for bone density, resulting in a decline in the diagnosis and treatment of osteoporosis, even for people who have already broken bones.

If this trend is not reversed, and soon, by better educating people with osteoporosis and their doctors, the result could be devastating, spawning an epidemic of broken bones, medical office visits, hospital and nursing home admissions and even premature deaths.

Currently, many people at risk of a fracture — and often their doctors — are failing to properly weigh the benefits of treating fragile bones against the very rare but widely publicized hazards of bone-preserving drugs, experts say.

One serious consequence already seems to have happened: a leveling off and possible reversal in what had been a decade-and-a-half-long decline in hip fractures among postmenopausal women, according to a new study of all women on Medicare who were hospitalized with an osteoporotic hip fracture between 2001 and 2015.

The data revealed a steady decline in hip fractures among women 65 and older on Medicare to 730 per 100,000 in 2015 from 931 per 100,000 in 2002. But starting in 2012, the rate adjusted for age suddenly leveled off. Had the decline continued, an estimated 11,464 fewer women would have broken their hips between 2012 and 2015, the researchers reported in December in the journal Osteoporosis International.

More ...

https://www.nytimes.com/2018/02/12/well/bone-fractures-broken-hip-osteoporosis-drugs-treatment-diagnosis.html?

Friday, February 9, 2018

Five major psychiatric diseases have overlapping patterns of genetic activity, new study shows - The Washington Post

Certain patterns of genetic activity appear to be common among five distinct psychiatric disorders — autism, schizophrenia, bipolar disorder, depression and alcoholism — according to a new study. The paper, appearing in the journal Science, was released Thursday.

Scientists analyzed data from 700 human brains, all donated either from patients who suffered one of these major psychiatric disorders or from people who had not been diagnosed with mental illness. The scientists found similar levels of particular molecules in the brains of people with autism, schizophrenia and bipolar disorder; other commonalities between bipolar and major depression; and other matches between major depression and alcoholism.

"We're on the threshold to using genomics and molecular technology to look at [mental illness] in a way we've never been able to do before," said Daniel Geschwind, a neurogeneticist at the University of California at Los Angeles and a leader of the study. "Psychiatric disorders have no obvious pathology in the brain, but now we have the genomic tools to ask what actually goes awry in these brains."

These shared, disease-related "signatures" involve a disruption in how brain cells communicate with one another.

"What we're seeing is giving us a sense of alterations in the way neurons are signaling to each other," Geschwind said. "We think some of it is confused activity. That's the next step, to connect it to the physiology: how do these changes affect neuronal firing and connectivity. We have a clue that it's adding 'noise' to the system. Maybe things are attenuated or jumbled."

More ...

https://www.washingtonpost.com/news/speaking-of-science/wp/2018/02/08/five-major-psychiatric-diseases-have-overlapping-patterns-of-genetic-activity-new-study-shows/?

Thursday, February 8, 2018

How People Die in America

Last week I published a long story about my near-fatal bacterial infection six months ago, and the material benefits that kept me alive. Since the piece ran I have been completely overwhelmed by reader responses.

Everyone, it seems, knows someone who has been financially ruined—or, in a roundabout way, killed—by the opaque mechanizations of our privatized health care system.

I survived, and I have a platform. But as one reader put it, "the people who die from having no insurance are not around to tell their stories."

Our politicians are fond of holding the line that no American dies for lack of access. Doctors and hospitals are bound by oath, the thinking goes, to do everything they can to save a life. But that logic doesn't account for the broader significance of the cycle of debt, or the way generations of families can be ruined by a single medical crisis. It glosses over the insane level of trust we are forced to put in the medical industry—the providers, the doctors, the insurance agents—when we have an accident or suddenly fall ill.

Since I published my own account of illness, I've seen lots of references to the now-deceased self-employed New York carpenter who won the lottery, used his newfound wealth to go to the doctor for the first time in decades, and found he had cancer in his brain and lungs. Someone sent me a link to this story about Susan Moore, a woman in Kentucky who elected to stop the dialysis she needed to stay alive because she couldn't afford to travel to the medical center three times a day.

I tweeted a handful of the comments on my story, but I wanted to post a couple more; these are the kinds of testimonies that can get lost in the glut of statistics about healthcare in this country.

More …

https://splinternews.com/how-people-die-in-america-1822743566?

How to Not Die in America 

On the second Tuesday in June, I start to feel fluish. If this is 2016 and I'm still a freelance writer, I'm losing money immediately on the assignments I can't complete because my vision is blurry and my thoughts are erratic. If this is 2013, I am soon taken off the roster at the cafe where I work.

I am out of my mind with anxiety as I hobble to the clinic, sweating, and pay $60 for cough syrup, $300 for the 10-minute visit (if I even have that in the bank; it's about a week's worth of my earnings slinging coffee). Once I realize I can't keep down the cough syrup and start spitting up bile, maybe I'm so feverish and broke I stay in bed without realizing the bacteria I've inhaled is more lethal than the flu. So perhaps I just up and die right there.

But let's say I somehow make it to the hospital. A friend drives me, because a 15-minute ambulance ride can cost nearly $2,000, which I don't have. I'm struggling financially and I've fallen behind on my ACA payments. My friend realizes in the car I'm not making any sense, and that's because my organs have already begun to shut down. My temperature is well over 100. When the doctors can't figure out what's wrong, they submit me to a credit check before advanced treatment.

More ...

https://splinternews.com/how-to-not-die-in-america-1822555151?

Monday, February 5, 2018

My Father’s Body, at Rest and in Motion | Siddhartha Mukherjee | The New Yorker

The call came at three in the morning. My mother, in New Delhi, was in tears. My father, she said, had fallen again, and he was speaking nonsense. She turned the handset toward him. He was muttering a slow, meaningless string of words in an unrecognizable high-pitched nasal tone. He kept repeating his nickname, Shibu, and the name of his childhood village, Dehergoti. He sounded as if he were reading his own last rites.

"Take him to the hospital," I urged her, from New York. "I'll catch the next flight home."

"No, no, just wait," my mother said. "He might get better on his own." In her day, buying an international ticket on short notice was an unforgivable act of extravagance, reserved for transcontinental gangsters and film stars. No one that she knew had arrived "early" for a parent's death. The frugality of her generation had congealed into frank superstition: if I caught a flight now, I might dare the disaster into being.

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https://www.newyorker.com/magazine/2018/01/08/my-fathers-body-at-rest-and-in-motion

A Doctor’s Painful Struggle With an Opioid-Addicted Patient - Siddhartha Mukherjee - The New York Times

I once found myself entrapped by a patient as much as she felt trapped by me. It was the summer of 2001, and I was running a small internal-medicine clinic, supervised by a preceptor, on the fourth floor of a perpetually chilly Boston building. Most of the work involved routine primary care — the management of diabetes, blood pressure and heart disease. It was soft, gratifying labor; the night before a new patient's visit, I would usually sift through any notes that were sent ahead and jot my remarks in the margins. The patient's name was S., I learned. She had made four visits to the emergency room complaining of headaches. Three of those times she left with small stashes of opioids — Vicodin, Percocet, oxycodone. Finally, the E.R. doctors refused to give her pain medicines unless she had a primary-care physician. There was an open slot in my clinic the next morning, and the computer had randomly assigned her to see me.

We were living, then, in what might be called the opioid pre-epidemic; the barometer had begun to dip, but few suspected the ferocity of the coming storm. Pain, we had been told as medical residents, was being poorly treated (true) — and pharmaceutical companies were trying to convince us daily that a combination of long- and short-acting opioids could cure virtually any form of it with minimal side effects (not true). The cavalier overprescription of addictive drugs was bewildering: After a tooth extraction, I emerged from an oral surgeon's office with a two-week supply of Percocet.

More ...

https://www.nytimes.com/2018/02/01/magazine/a-doctors-painful-struggle-with-an-opioid-addicted-patient.html

Friday, February 2, 2018

India Wants to Give Half a Billion People Free Health Care - The New York Times

India announced on Thursday a sweeping plan to give half a billion poor Indians free access to health care, as Prime Minister Narendra Modi seeks to address rising demands for greater economic and social protections before national elections next year.

The move is sure to be popular in a country where most people have no health insurance and the per capita income is a few dollars a day. Although India's overall economy is growing, Mr. Modi and his governing Bharatiya Janata Party have been trying to find ways to court the population left behind.

"In poor people's lives, one big worry is how to treat illness," Mr. Modi tweeted in Hindi after the plan was announced. The new program, he said, "will free poor people from this big worry."

The health care plan, part of the government's 2018-19 budget presented on Thursday, would offer 100 million families up to 500,000 rupees, or about $7,860, of coverage each year. That sum, while small by Western standards, would be enough to cover the equivalent of five heart surgeries in India. Officials did not outline eligibility requirements, and many details of the program have yet to be finalized.

India's finance minister, Arun Jaitley, said in a speech to Parliament that the plan would cover more people than any other government-funded health care program in the world. In addition to the direct health benefits, he said, the program would create hundreds of thousands of jobs.

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https://www.nytimes.com/2018/02/01/business/india-modi-health-care.html?

Doctor Visit Guide - Well Guides - The New York Times

Going to the doctor isn't most people's favorite activity. But it is part of staying healthy (the other major parts are what you eat and how much you exercise). So you may as well get the most out of it. As a doctor I often get asked by friends and family how to make the most of a medical visit. Here's my advice, and it's basically the same whether you are the patient, or a family member or a caregiver of the patient.

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https://www.nytimes.com/guides/well/make-the-most-of-your-doctor-appointment

Friday, January 26, 2018

A Doctor Argues That Her Profession Needs to Slow Down, Stat - The New York Times

Doctors today often complain of working in an occupational black hole in which patient encounters are compressed into smaller and smaller space and time. You can do a passable job in a 10-minute visit, they say, but it is impossible to appreciate the subtleties of patient care when you are rushing.

Enter "Slow Medicine: The Way to Healing," a wonderful new memoir by Dr. Victoria Sweet. The term "slow medicine" has different interpretations. For some it means spending more time with patients. For others it means taking the time to understand evidence so as to avoid overdiagnosis and overtreatment. For Sweet, it means "stepping back and seeing the patient in the context of his environment," and providing medical care that is "slow, methodical and step-by-step."

At the beginning of her book, she relates how her 93-year-old father was mistreated after being hospitalized for a seizure. He is put in 4-point restraints and sedated. Bloody urine drains from his bladder because it has been injured by a catheter insertion. Worse, his rushed doctors don't know that this isn't his first seizure but rather the latest in a long line that can be managed at home.

The steamroller of inpatient care takes over. Every day Sweet's father sees a different doctor. He isn't allowed to eat or get out of bed because he is on tranquilizers. He becomes septic. His symptoms are misdiagnosed as a stroke. Doctors eventually prepare to insert a feeding tube into his stomach because he cannot swallow. Sweet and her sisters get him out of the hospital just in time. When he gets home, he has a steak and a beer.

Sweet writes, "If I, as a physician, couldn't get appropriate care for a family member in a lovely community hospital with well-trained staff — who could?"

More ...

https://www.nytimes.com/2018/01/26/books/review/slow-medicine-victoria-sweet-memoir.html?

Why do hospitals bare butts when there are better gowns around? | STAT

Every decade or so, the headlines reappear:

"Fashion designer Cynthia Rowley updates hospital wear for patients" (United Press International, June 1999)

"Diane von Furstenberg Redesigns the Hospital Gown" (GOOD, September 2010)

"The Hospital Gown Gets a Modest Redesign" (The New York Times, January 2018)


Each redesign, of course, targets the old-school, butt-baring gown that's long been a touchstone of cultural commiseration in movies, TV, and comic strips.

But if everyone agrees that the old garments are horrible, and if fashion designers — working with doctors and nurses, no less — have created better gowns, why are we still having this conversation?

The higher cost of new gowns is a big reason why many hospitals still use traditional tie-in-the-back johnnies. In addition, some fans of the old design think the new versions aren't patient-friendly enough, and the standard ones are just fine; they're convenient and functional, giving easy access to parts of the body clinicians need to poke and prod.

"There's now an effort to be more patient-centric, but really it's the institutional viewpoint of what patient-centric means, not the individual's viewpoint," said Timothy Andrews, a health industry analyst at Booz Allen Hamilton, a Virginia-based consultancy. Andrews said he visits Boston hospitals regularly for diabetes and dermatology checkups, and he continues to receive traditional tie-in-the-back gowns.

"You might as well just walk around naked," he said. "It's probably easier — just give us a belt and a loincloth."

More ...

https://www.statnews.com/2018/01/25/hospital-gowns-design/?