Saturday, August 27, 2016

Overselling A.D.H.D.: A New Book Exposes Big Pharma’s Role - The New York Times

In the late 1930s, Charles Bradley, the director of a home for "troublesome" children in Rhode Island, had a problem. The field of neuroscience was still in its infancy, and one of the few techniques available to allow psychiatrists like Bradley to ponder the role of the brain in emotional disorders was a procedure that required replacing a volume of cerebrospinal fluid in the patient's skull with air. This painstaking process allowed any irregularities to stand out clearly in X-ray images, but many patients suffered excruciating headaches that lasted for weeks afterward.

Meanwhile, a pharmaceutical company called Smith, Kline & French was facing a different sort of problem. The firm had recently acquired the rights to sell a powerful stimulant then called "benzedrine sulfate" and was trying to create a market for it. Toward that end, the company made quantities of the drug available at no cost to doctors who volunteered to run studies on it. Bradley was a firm believer that struggling children needed more than a handful of pills to get better; they also needed psychosocial therapy and the calming and supportive environment that he provided at the home. But he took up the company's offer, hoping that the drug might eliminate his patients' headaches.

It did not. But the Benzedrine did have an effect that was right in line with Smith, Kline & French's aspirations for its new product: The drug seemed to boost the children's eagerness to learn in the classroom while making them more amenable to following the rules. The drug seemed to calm the children's mood swings, allowing them to become, in the words of their therapists, more "attentive" and "serious," able to complete their schoolwork and behave. Bradley was amazed that Benzedrine, a forerunner of Ritalin and Adderall, was such a great normalizer, turning typically hard-to-manage kids into models of complicity and decorum. But even after marveling at the effects of the drug, he maintained that medication should be considered for children only in addition to other forms of therapy.

Bradley's research was ignored for a couple of decades as psychoanalysis became dominant in the United States. But his discoveries laid the foundation for one of the most aggressive marketing campaigns in history, which succeeded not only in helping to transform the nascent drug industry into the multinational juggernaut known as Big Pharma, but in convincing parents, physicians and ­public health officials that 15 percent of American schoolchildren are sick enough that they would require powerful medication just to get through the day.

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http://www.nytimes.com/2016/08/28/books/review/adhd-nation-alan-schwarz.html

Thursday, August 25, 2016

Doctors Learn Improv to Improve Bedside Manner - The Atlantic

There is something about the ER—especially the night shift—that thrives on spontaneity.

It's just past 2 a.m. I meet him for the first time in a hallway stretcher—one step past the waiting room and any number of hours before he inherits a bed with privacy. The patient is a 50-something Caucasian man with salt-and-pepper hair, battered glasses, a three-day beard, and an air of frustration. He wants to know why—why the long wait, why he's constantly in pain, and why we can't immediately comply with his request for narcotics.

I start to gather information as we are trained to do. I utter some version of "what brings you into the ER today?" I carry on with more questions, registering each answer on my mental checklist.

"Look, I really don't want to be here right now," he says with defeat.

I pause.

I tuck away my pen and paper—and with them, my persistence.

"You know, to be honest, I wouldn't mind being at home in my own bed right now either," I offer.

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http://www.theatlantic.com/education/archive/2016/08/what-improv-can-teach-tomorrows-doctors/497177/?

Precision Test For Breast Cancer Treatment Remains Imprecise : Shots - Health News : NPR

A major study about the best way to treat early-stage breast cancer reveals that "precision medicine" doesn't provide unambiguous answers about how to choose the best therapy.

"Precision doesn't mean certainty," says David Hunter, a professor of cancer prevention at Harvard's T.H. Chan School of Public Health.

That point is illustrated in a large study published Wednesday in the New England Journal of Medicine, involving decisions about chemotherapy.

As is true for many cancers, breast cancer responds best to treatment when it is caught early, before it has spread throughout the body. Dr. Fatima Cardoso, the study's lead author and a breast cancer specialist at the Champalimaud Clinical Center in Lisbon, Portugal, says that creates a conundrum for doctors and patients alike.

Because it's the only opportunity to cure the cancer, "when in doubt we tend to treat" women with early-stage breast cancer, she told Shots. "So we know that we overtreat the patients with early breast cancer."

That means that women could end up undergoing chemotherapy even if it wouldn't really improve their survival odds.

Hoping to refine those treatment decisions, Cardoso helped organize a huge study throughout Europe to see whether a commercially available genetic test called MammaPrint could help reduce that overtreatment. More than 6,600 women participated at 112 institutions in nine nations.

Scientists identified women with breast cancer whose physical exams suggested they were at relatively high risk for having the cancer return eventually after surgery, but who seemed to be at low risk of recurrence based on the genetic test results.

They were invited to participate in the study, which would randomly assign them to have chemotherapy or not. "You know that chemotherapy is a treatment that scares people, so overall and for the majority of patients, it was not difficult to convince them," Cardoso says.

The genomic test, which studies 70 distinct features of a tumor, did a pretty good job of predicting who was at low risk for recurrence of breast cancer and could therefore avoid the pain, discomfort and risks of chemotherapy. (The test, priced at $4,200, is covered by some insurance in the United States.)

The scientists found that 46 percent of women who were deemed to be at high risk of recurrence based on physical symptoms could actually skip chemotherapy with little consequence to their long-term survival.

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http://www.npr.org/sections/health-shots/2016/08/24/491213713/study-of-breast-cancer-treatment-reveals-paradox-of-precision-medicine

Wednesday, August 24, 2016

NYTimes: The Life-Changing Magic of Choosing the Right Hospital

There's an exceedingly simple way to get better health care: Choose a better hospital. A recent study shows that many patients have already done so, driving up the market shares of higher-quality hospitals.

A great deal of the decrease in deaths from heart attacks over the past two decades can be attributed to specific medical technologies like stents and drugs that break open arterial blood clots. But a study by health economists at Harvard, M.I.T., Columbia and the University of Chicago showed that heart attack survival gains from patients selecting better hospitals were significant, about half as large as those from breakthrough technologies.

That's a big improvement for nothing more than driving a bit farther to a higher-quality hospital.

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http://www.nytimes.com/2016/08/23/upshot/the-life-changing-magic-of-choosing-the-right-hospital.html?

Tuesday, August 23, 2016

Doctors thought it was a simple foot infection. They were so wrong. - The Washington Post

Melissa Curley Bogner was baffled: Why did her feet feel suddenly hot — in January?

The 41-year-old management analyst for the Navy had grown accustomed to periodic bouts of neuropathy — numbness in her hands and feet — the apparent legacy of a severe allergic reaction to a drug she took in 2000 to treat a gynecological infection.

But this 2015 episode was different. Along with the sensation that her feet felt unusually warm, the skin on the second toe of her right foot looked inflamed. Weeks later, she noticed a small blister.

Bogner, who lives in Southern Maryland, initially shrugged it off. She figured that whatever was wrong would go away on its own.

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https://www.washingtonpost.com/national/health-science/doctors-thought-it-was-a-simple-foot-infection-they-were-so-wrong/2016/08/22/7d6347e4-36ed-11e6-9ccd-d6005beac8b3_story.html?

Saturday, August 20, 2016

Rudeness in Medical Settings Could Kill Patients

Imagine this: You're a cardiac surgeon who is pushing into the five-hour mark of a complicated seven-hour surgery. You ask a nurse for a specific tool, and he drops it. It's now contaminated and useless. The nurse stands dumbstruck until you snap at him to hurry up, grab another tool, and stop being so clumsy. You were rude, but he deserved it, right? He'll get over the uncivil remark and everybody will move on. But that "moving on" actually might not happen — according to a recent study, rude comments in high-pressure medical settings could have potentially deadly effects on patients.

The study, "The Impact of Rudeness on Medical Team Performance: A Randomized Trial," which was published in the September issue of Pediatrics, shows that a rude comment from a third-party doctor decreased performance among doctors and nurses by more than 50 percent in an exercise involving a hypothetical life-or-death situation. "We found that rudeness damages your ability to think, manage information, and make decisions," said Amir Erez, an author on the study and a Huber Hurst professor of management at the University of Florida. "You can be highly motivated to work, but if rudeness damages your cognitive system then you can't function appropriately in a complex situation. And that hurts patients."

For the experiment, Erez and his colleagues gave 24 medical teams from neonatal intensive care units in Israeli hospitals, each composed of one doctor and two nurses, an hour to diagnose and treat a simulated case of necrotizing enterocolitis, a rapid and potentially fatal disease in which a premature newborn's intestinal tissue becomes inflamed and starts to necrotize, or die.

Before beginning, the teams were informed that a leading ICU expert from the United States would be observing them via webcam. The researcher running the experiment then dialed a fake phone number and played a (prerecorded) message that was supposedly from the observer. The message informed half of the participants that he had observed other medical teams and was "not impressed with the quality of medicine in Israel," but told the control group simply that he had observed other teams, without making any rude comments or insults. Ten minutes into the simulation the teams were interrupted by another prerecorded message from the researcher. He told the control group that he hoped the workshop helped them improve as physicians; he told the other teams, however, that the Israeli physicians and nurses he'd been observing "wouldn't last a week" in his department.

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http://nymag.com/scienceofus/2015/10/rudeness-in-hospitals-could-kill-patients.html?x=1

Institute For Safe Medication Practices

• Collect and analyze reports of medication-related hazardous conditions, near-misses, errors, and other adverse drug events.

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• Educate the healthcare community and consumers about safe medication practices.

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• Advocate the adoption of safe medication standards by accrediting bodies, manufacturers, policy makers, regulatory agencies, and standards-setting organizations.

• Conduct research to provide evidence-based safe medication practices.

http://www.ismp.org/default.asp

ConsumerMedSafety.org - Prevent Medication Errors

ConsumerMedSafety.org is provided to you by the Institute for Safe Medication Practices (ISMP). This unique website is designed to help you, the consumer, avoid mistakes when taking medicines. Preventing medication errors is a huge responsibility that doctors, pharmacists, and nurses take seriously. But you, too, can play a vital role in preventing dangerous errors, and ConsumerMedSafety.org is exactly what you need to protect yourself and your loved ones!

The majority of the material provided on our website, is original, written by the ISMP staff. Content is developed from

• Reports submitted to the Medication Error Reporting Program (MERP) by practitioners and consumers with research by our editorial staff to confirm and validate.
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Together the readership exceeds 2 million. More information about our publication can be seen at: http://www.ismp.org/Newsletters/default.asp

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‘America’s other drug problem’: Giving the elderly too many prescriptions - The Washington Post

Dominick Bailey sat at his computer, scrutinizing the medication lists of patients in the geriatric unit.

A doctor had prescribed blood pressure medication for a 99-year-old woman at a dose that could cause her to faint or fall. An 84-year-old woman hospitalized for knee surgery was taking several drugs that were not meant for older patients because of their severe potential side effects.

And then there was 74-year-old Lola Cal. She had a long history of health problems, including high blood pressure and respiratory disease. She was in the hospital with pneumonia and had difficulty breathing. Her medical records showed she was on 36 medications.

"This is actually a little bit alarming," said Bailey, a pharmacist.

He was concerned about the sheer number of drugs but even more worried that several of them — including ones to treat insomnia and pain — could suppress Cal's breathing.

An increasing number of elderly patients nationwide are on multiple medications to treat chronic diseases, raising their chances of dangerous drug interactions and serious side effects. Often the drugs are prescribed by different specialists who don't communicate with each other. If those patients are hospitalized, doctors making the rounds add to the list — and some of the drugs they prescribe may be unnecessary or unsuitable.

"This is America's other drug problem — polypharmacy," said Maristela Garcia, director of the inpatient geriatric unit at UCLA Medical Center in Santa Monica, Calif. "And the problem is huge."

More ...

https://www.washingtonpost.com/national/health-science/americas-other-drug-problem-giving-the-elderly-too-many-prescriptions/2016/08/15/e406843a-4d17-11e6-a7d8-13d06b37f256_story.html

Tuesday, August 16, 2016

‘America’s other drug problem’: Giving the elderly too many prescriptions - The Washington Post

Dominick Bailey sat at his computer, scrutinizing the medication lists of patients in the geriatric unit.

A doctor had prescribed blood pressure medication for a 99-year-old woman at a dose that could cause her to faint or fall. An 84-year-old woman hospitalized for knee surgery was taking several drugs that were not meant for older patients because of their severe potential side effects.

And then there was 74-year-old Lola Cal. She had a long history of health problems, including high blood pressure and respiratory disease. She was in the hospital with pneumonia and had difficulty breathing. Her medical records showed she was on 36 medications.

"This is actually a little bit alarming," said Bailey, a pharmacist.

More ...

https://www.washingtonpost.com/national/health-science/americas-other-drug-problem-giving-the-elderly-too-many-prescriptions/2016/08/15/e406843a-4d17-11e6-a7d8-13d06b37f256_story.html