Friday, March 20, 2009

“Please, do not make us suffer any more…” | Human Rights Watch

UN General Assembly's Special Session on Drugs should address the lack of access to pain relief medicines, which leaves tens of millions of people worldwide suffering from severe but treatable pain, a leading rights watch body said on Sunday.

Human Rights Watch (HRW)in a report said that these pain relieving medicines are not available to people despite its low cost and the summit, which is starting from March 11, is an opportunity for all countries to address the the issue.

In its 47-page report, "'Please, Don't Make Us Suffer Anymore: Access to Pain Treatment as a Human Right", HRW said that countries could significantly improve access to pain medications by addressing the causes of their poor availability.

"Severe pain can easily be treated with inexpensive medications, so it is inexcusable that millions of people have to live and die in agony," Diederik Lohman, senior researcher in Human Rights Watch's health and human rights division, said.

"The UN drugs summit provides an opportunity for governments to give real meaning to their commitment to end this unnecessary suffering." he added. Failure to put in place functioning supply and distribution systems, absence of government policies to ensure their availability, insufficient instruction for healthcare workers, excessively strict drug-control regulations; and fear of legal sanctions among healthcare workers has made these drugs inaccessible, the report said.

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Thursday, March 19, 2009

Study Finds PSA Test Saves Few Lives -

The PSA blood test, used to screen for prostate cancer, saves few lives and leads to risky and unnecessary treatments for large numbers of men, two large studies have found.

The findings, the first based on rigorous, randomized studies, confirm some longstanding concerns about the wisdom of widespread prostate cancer screening. Although the studies are continuing, results so far are considered significant and the most definitive to date.

The PSA test, which measures a protein released by prostate cells, does what it is supposed to do — indicates a cancer might be present, leading to biopsies to determine if there is a tumor. But it has been difficult to know whether finding prostate cancer early saves lives. Most of the cancers tend to grow very slowly and are never a threat and, with the faster-growing ones, even early diagnosis might be too late.

The studies — one in Europe and the other in the United States — are "some of the most important studies in the history of men's health," said Dr. Otis Brawley, the chief medical officer of the American Cancer Society.

In the European study, 48 men were told they had prostate cancer and needlessly treated for it for every man whose death was prevented within a decade after having had a PSA test.

Dr. Peter B. Bach, a physician and epidemiologist at Memorial Sloan-Kettering Cancer Center, says one way to think of the data is to suppose he has a PSA test today. It leads to a biopsy that reveals he has prostate cancer, and he is treated for it. There is a one in 50 chance that, in 2019 or later, he will be spared death from a cancer that would otherwise have killed him. And there is a 49 in 50 chance that he will have been treated unnecessarily for a cancer that was never a threat to his life.

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Wednesday, March 18, 2009

Health care overhaul may cost about $1.5 trillion

Guaranteeing health insurance for all Americans may cost about $1.5 trillion over the next decade, health experts say. That's more than double the $634 billion 'down payment' President Barack Obama set aside for health reform in his budget, raising the prospect of sticker shock at a time of record federal spending. Administration officials have pointedly avoided providing a ballpark estimate, saying it depends on details to be worked out with Congress.

"It's impossible to put a price tag on the plan before even the basics have been finalized," said White House spokesman Reid Cherlin. "Here's what we do know: The reserve fund in the president's budget is fully paid for and provides a substantial down payment on the cost of the reforming our health care system."

Still, the potential runaway costs are raising concerns among Republicans and some Democrats as Congress prepares to draft next year's budget. The U.S. spends $2.4 trillion a year on health care, more than any other advanced country. And some experts estimate that a third or more of that goes for tests and procedures that provide little or no benefit.

"We shouldn't just be throwing more money on top of the present system, because the present system is so wasteful," said Sen. Judd Gregg of New Hampshire, the ranking Republican on the Budget Committee.

The health care plan Obama offered as a candidate would have cost nearly $1.2 trillion over ten years, according to a detailed estimate last fall by the Lewin Group, a leading consulting and policy analysis firm. The campaign plan would not have covered all the uninsured, as most Democrats in Congress want to do. But it is a starting point for lawmakers.

John Sheils, a senior vice president of the Lewin Group, said about $1.5 trillion to $1.7 trillion would be a credible estimate for a plan that commits the nation to covering all its citizens. That would amount to around 4 percent of projected health care costs over the next 10 years, he added.

The cost of covering the uninsured is "a difficult hurdle to get over," Sheils said in an interview.

"I don't know where the rest of the money is going to come from," he added.

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Tuesday, March 17, 2009

Top Pain Scientist Fabricated Data in Studies, Hospital Says -

A prominent Massachusetts anesthesiologist allegedly fabricated 21 medical studies that claimed to show benefits from painkillers like Vioxx and Celebrex, according to the hospital where he worked.

Baystate Medical Center, Springfield, Mass., said that its former chief of acute pain, Scott S. Reuben, had faked data used in the studies, which were published in several anesthesiology journals between 1996 and 2008.

The hospital has asked the medical journals to retract the 21 studies, some of which reported favorable results from the use of painkillers like Pfizer Inc.'s Bextra and Merck & Co.'s Vioxx -- both since withdrawn -- as well as Pfizer's Celebrex and Lyrica. Dr. Reuben's research work also claimed positive findings for Wyeth's antidepressant Effexor XR as a pain killer. And he wrote to the Food and Drug Administration, urging the agency not to restrict the use of many of the painkillers he studied, citing his own data on their safety and effectiveness.

"Dr. Reuben deeply regrets that this happened," said the doctor's attorney, Ingrid Martin. "Dr. Reuben cooperated fully with the peer review committee. There were extenuating circumstances that the committee fairly and justly considered." She declined to explain the extenuating circumstances. Dr. Reuben didn't respond to requests for comment sent through Ms. Martin and left at his former office.

The retractions, first reported in Anesthesiology News, have caused anesthesiologists to reconsider the use of certain practices adopted as a result of Dr. Reuben's research, doctors said. His work is considered important in encouraging doctors to combine the use of painkillers like Celebrex and Lyrica for patients undergoing common procedures such as knee and hip replacements.

Last month, the journal Anesthesia & Analgesia retracted 10 of Dr. Reuben's studies and posted a list of the 11 published in other journals on its Web site. The journal Anesthesiology said it has retracted three of Dr. Reuben's articles.

Dr. Reuben had been a paid speaker on behalf of Pfizer's medicines, and it paid for some of his research. "It is very disappointing to learn about Dr. Scott Reuben's alleged actions," Pfizer said in a statement. "When we decided to support Dr. Reuben's research, he worked for a credible academic medical center and appeared to be a reputable investigator."

Wyeth said it isn't aware of any financial relationship between the company and Dr. Reuben.

An FDA spokeswoman said late Tuesday she wasn't aware of the matter. Merck had no immediate comment.

Hal Jenson, the chief academic officer at Baystate Medical, said a routine audit last spring flagged discrepancies in Dr. Reuben's work. That led to a larger investigation in which Dr. Reuben cooperated, Dr. Jenson said. "The conclusions are not in dispute," he added.

Dr. Reuben is on an indefinite leave from his post at Baystate, the hospital said. He no longer holds an appointment as a professor at Tufts University's medical school, according to the university.

Baystate concluded that "Dr. Reuben was solely responsible for the fabrication of data," Dr. Jenson said.

Jeffrey Kroin, who co-wrote four papers with Dr. Reuben, said he was dumbfounded to receive a letter earlier this year from Baystate, retracting the studies.

"We analyzed it and made figures and graphs, and sent it back, and wrote papers, and everything seemed fine," said Dr. Kroin of Rush University Medical Center in Chicago. "If someone has a good reputation, has 10 years of papers and has a very high position within their medical school, generally you assume they have a lot of integrity."

Jacques E. Chelly, the head of acute interventional postoperative pain service at the University of Pittsburgh Medical Center, said he was "shocked" by the news of the retractions. Dr. Reuben "was very well respected," Dr. Chelly said.

He added that the situation has prompted his hospital to review the protocols it uses to treat patients for pain, because Dr. Reuben's work was so influential in establishing them. He said the hospital was now conducting its own study to verify the efficacy of drugs that Dr. Reuben claimed were effective painkillers.

In an editorial in the journal Anesthesiology, editor James C. Eisenach warned that "these retractions clearly raise the possibility that we might be heading in wrong directions or toward blind ends in attempts to improve pain therapy."

The retracted studies aren't expected to affect the drugs' regulatory status because Dr. Reuben's studies weren't part of the packages that manufacturers submitted to the FDA or European authorities.

The Atlantic Online | April 2009 | The Case Against Breast-Feeding | Hanna Rosin

In certain overachieving circles, breast-feeding is no longer a choice—it's a no-exceptions requirement, the ultimate badge of responsible parenting. Yet the actual health benefits of breast-feeding are surprisingly thin, far thinner than most popular literature indicates. Is breast-feeding right for every family? Or is it this generation's vacuum cleaner—an instrument of misery that mostly just keeps women down?

Diagnosis - Mysterious Psychosis -

The patient lay on the bed, her eyes wide with fear as she struggled for breath. The nurse at the bedside looked almost as scared. She turned as Dr. Kennedy Cosgrove entered the hospital room and said, "I can't get a blood pressure, doctor — her pressure is too high for me to measure." Cosgrove felt his own blood pressure soar. Most patients in this psychiatric ward of Stevens Hospital in Edmonds, Wash., were physically healthy, and Cosgrove, a psychiatrist, hadn't managed this type of emergency since his internship. He ordered an EKG and quickly phoned the internal-medicine doctor on call.

Ten days earlier, the patient was taken to the hospital's emergency room by the police. According to their report, she phoned her teenage son to say goodbye — she was going to take her life. He and the police found her at home, shouting, incoherent, weeping.

When Cosgrove met her later that day, his first thought was that despite her erratic behavior — which wasn't unusual in this ward — she looked different from his other patients. Her hair was well cut. Her nails were clean and manicured. She looked tired and disheveled, but she didn't look chronically mentally ill.

After introducing himself, Cosgrove asked the patient if she knew why she was there. Tears filled her eyes. She couldn't take the disappointment of life anymore, she told him. He nodded sympathetically. She shifted restlessly on the bed. "I've had seven death attempts on me — by the police!" she shouted, suddenly angry. Her eyes narrowed suspiciously. "Have you heard this?" There was a conspiracy against her — organized by the state of Washington and the Boeing Company. Sometimes she could even hear them talking to her — their voices coming from inside her own brain. She laughed giddily and then became angry again. "Get out! Get out! Get out!"

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Accepting the Risks in Creating Confident Doctors

What does it take to make a medical expert? Practice, practice, practice. And, unfortunately, some error along the way.

Patients instinctively know this, which explains the near universal preference for a seasoned doctor over a freshly minted one. I have yet to hear a patient clamor to be treated by a young resident.

Medical educators are keenly aware of it, too, and of a conflict at the heart of medical training: what may be best for making a skilled, independent-thinking doctor may not always be best for patient comfort or safety.

How, for example, can an inexperienced psychiatry resident learn how to do empathetic but rigorous interviewing to assess patients' risk of harming themselves or others, without leaving some patients feeling misunderstood or badly treated? How can a doctor become expert at using psychotropic drugs or doing psychotherapy without making mistakes along the way?

Just as we want psychiatrists in training to become confident and knowledgeable, we also have to protect patients from the errors that result from their inexperience.

But one day, our residents will leave the protective cocoon of training and go out on their own. Have we struck the right balance among education and training and patient safety to produce psychiatrists who can function independently? I'm not sure we have.

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12 Most Annoying Bad Habits of Therapists

The mental health Web site PsychCentral notes that we all have bad habits. But when the person with the bad habit is your therapist, it has "the very real potential of interfering with the psychotherapy process."

Here, according to PsychCentral founder John M. Grohol, are the 12 most annoying habits patients complain about, and some additional thoughts from readers.

1. Showing up late for the appointment: Some therapists consistently show up late for their appointments with their clients — anywhere from five minutes to even two hours.

2. Eating in front of the client: Asking, "Do you mind if I finish my lunch while we get started?" is inappropriate. Reader MostlyHarmless commented:

My appointments were at 1:00 p.m., and my therapist used my time EVERY week as her lunch hour, even though my binge eating was a major issue.

3. Yawning during a session: Believe it or not, there are therapists who fall asleep during session. Reader Nancy noted:

I had a therapist who fell asleep during every session. It turns out she was actually taking too many pain pills after foot surgery, but I didn't know that. I would be sharing intimate details of what was bothering me and look up and she would be sawing logs. How rude! Needless to say I stopped seeing her.

4. Too Much Information: It's the client's therapy, not the therapist's. Reader Lynn commented:

I briefly saw a psychiatrist who told me her whole life story – repeatedly. Every comment I made triggered a long story about her life. I stopped going to therapy because it seemed like such a waste of time to spend most of the session listening to her talk about her own experiences.

5. Being impossible to reach by phone or e-mail. Waiting a week for a return phone call is unacceptable in virtually any profession, including psychotherapy.

6. Becoming distracted by a phone, cellphone or computer. Therapists should never accept any phone calls while in session (except for true emergencies), and they should turn away from any other distractions, such as a computer screen.

7. Expressing racial, sexual, musical, lifestyle and religious preferences. A therapist who spends time discussing favorite musicians is not likely helping the client.

8. Pets: Pets are generally not an appropriate part of psychotherapy. Reader Suzanne said:

I have a friend who goes to a therapist who eats during the season, has THREE dogs wandering around, is chronically late.

9. Hugging and physical contact. Some clients are disturbed by touching or hugging, and want no part of it. Reader Lily wrote:

I had one therapist who seemed overly concerned with whether I liked her or not. She would frequently ask me if I liked her, how I felt about her, and she would give me small gifts. I was uncomfortable with it all.

10. Inappropriate displays of wealth or dress. Too much jewelry or skin can be off-putting. Reader Freeda said her therapist was:

A lady dressed to the hilt with a load of large metal accessories like belts, earrings and bracelets–she clanked as she moved.

11. Clock watching. The therapist who hasn't learned how to tell the time without checking the clock every five minutes is going to be noticed by the client.

12. Excessive note-taking. Taking notes, if necessary, should be discreet. Constant note-taking is a distraction for most clients. Reader SharonM said:

An Outbreak of Autism, or a Statistical Fluke?

"I know 10 guys whose kids have autism," said Ayub's father, Abdirisak Jama, a 39-year-old security guard. "They are all looking for help."

Autism is terrifying the community of Somali immigrants in Minneapolis, and some pediatricians and educators have joined parents in raising the alarm. But public health experts say it is hard to tell whether the apparent surge of cases is an actual outbreak, with a cause that can be addressed, or just a statistical fluke.

In an effort to find out, the Minnesota Department of Health is conducting an epidemiological survey in consultation with the federal Centers for Disease Control and Prevention. This kind of conundrum, experts say, arises whenever there is a cluster of noncontagious illnesses.

While there is little research on autism clusters, reports of cancer clusters are so common that health agencies across the country respond to more than 1,000 inquiries about suspected ones each year. A vast majority prove unfounded, and even when one is confirmed, the cause is seldom ascertained, as it was for Kaposi's sarcoma among gay men and mesothelioma among asbestos workers.

It is "extraordinarily difficult" to separate chance clusters from those in which everyone was exposed to the same carcinogen, said Dr. Michael J. Thun, the American Cancer Society's vice president for epidemiology.

Since the cause of autism is unknown, the authorities in Minnesota say it is hard to know even what to investigate.

"There are obviously some real concerns here, but we don't want to make a cursory judgment," said Buddy Ferguson, a health department spokesman. Even counting autism cases is difficult because the diagnoses are first made by the schools, not doctors, and population estimates for Somalis vary widely. Results are expected late this month.

Even if the department confirms that a cluster exists, it will not answer the question why. Still, Dr. Thun said a possible focus in one ethnic group "increases my sense that investigating it is essential." The next step, he added, would be to look at Somalis in other cities.

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When It Isn’t Really Senility

When Jane Simpson's mother, then 91, started showing signs of memory loss in December 2007, Ms. Simpson thought age had finally caught up with her. "As this had been a gradual process, and considering her age, we were not unduly alarmed — just saddened that it seemed we were losing my mother mentally," she wrote in an e-mail to this blog.

But on a visit six months later, Ms. Simpson, a 61-year-old advertising copywriter in North Carolina, was struck by how much worse her mother's memory loss had become and by her confusion about everything happening around her.

Just typical 91-year-old behavior? Just the first signs of the inevitable slide toward dementia we all may face if we live long enough? Not at all.

Since the '70s, geriatric specialists have been aware of many unusual causes of memory loss, confusion and disorientation in older people. These include not just medical conditions ranging from urinary tract infection to hydrocephalus to the flu, but also side effects from many commonly used medications.

Often, doctors and family members disregard these symptoms, thinking that they are just signs of an inevitable age-related decline. But many cases of pseudo-senility, as it's called, are reversible — if they are caught early enough.

By coincidence, Ms. Simpson had recently read a short article in her local newspaper about the side effects in the elderly of a bladder control drug called Ditropan, which include severe memory loss. Her mother was taking Ditropan.

Ms. Simpson and her sister got their mother switched to an alternative bladder control drug, Enablex. Sure enough, her mental symptoms eased. "Within three months," Ms. Simpson recalled in her e-mail, "we felt that we had our mother back."

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Sunday, March 15, 2009

Bad Economy Leads Patients To Put Off Surgery, or Rush It -

As the recession deepens, doctors and hospitals are reporting that hard-pressed patients are deferring elective surgery, like knee replacements and nose jobs, even as others are speeding up non-urgent procedures out of fear that they may soon lose their jobs and health insurance.

With unemployment still rising, there are wide variations by region and type of surgery. That means that highly regarded orthopedic surgeons in Chicago may be as busy as ever, while gastroenterologists in Atlanta are scrambling to fill cancellations.

But even those whose operating rooms are booked months in advance say they anticipate a slowdown later this year.

Delaying elective procedures can have serious medical consequences, as when a detectable polyp develops into a tumor because a patient skips a colonoscopy. Some hospitals said their emergency rooms were already seeing patients with dire conditions that could have been avoided had they not deferred surgery for economic reasons.

"We're probably seeing five or six of those a day at each of our hospitals," said Zeff Ross, a senior vice president at Memorial Healthcare System, which operates six hospitals in South Florida. "Someone gets an attack of diverticulitis, but they wait. They get it a second time and the doctor tells them to get the surgery done now, but they still wait. The third time, it perforates and that's a much tougher surgery, much more dangerous for the patient and with a longer length of stay."

The slowdown is likely to have significant financial repercussions. Elective operations are typically covered by private insurance plans that tend to reimburse hospitals and doctors at higher rates than government insurance programs like Medicare and Medicaid. As those payments dwindle, so do hospital profit margins and the resources to provide charity care to a growing number of uninsured.

"Elective admissions could represent only 9 or 10 percent of a hospital's admissions and yet represent 25 percent of its bottom line," said Michael A. Sachs, chief executive of Sg2, a health care consulting firm. "They're the patients that subsidize the underfunding associated with Medicaid and Medicare patients and uncompensated care."

The loss of revenue and growth in uncompensated care is conspiring with other byproducts of the recession — declining philanthropy, battered investments and tight credit — to force many hospitals to lay off workers, postpone expansions and cancel equipment purchases.

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