Friday, July 17, 2015
The dead man—"H: 71 inches," as scrawled on the autopsy-room whiteboard—is laid out on a metal table, head propped up on a plastic block. The body is naked, marked only by a neon-yellow hospital bracelet and a paper toe tag. The flesh—now grey and exposed—is stretched tautly over bone. The feet are swollen, blackening; all the muscles are tensed, the face thrown back. It's a wan, triangular face, with few wrinkles for a middle-aged man. The chin is dotted with stubble.
The man had died eight hours earlier at a hospital in the University of Pittsburgh Medical Center (UPMC) hospital system, where the pathologist Jeffrey Nine directs the autopsy service. Nine suspects the man died of a heart attack, but the family wants to be sure, so Nine, his chief pathology resident, and two students training as pathologists' assistants set to work performing an autopsy. (The man's family wasn't told that I would be present at his autopsy, but Nine made sure to shield me from any details that might identify the man.)
Thursday, July 16, 2015
Because of stringent rules from her drug plan and the pharmacy she is required to use, Ms. Short cannot order a refill until her monthly supply is three-quarters gone. Yet processing a refill takes about seven days, making it touch and go whether the new shipment will arrive before the old one runs out.
"You just feel like every month, you're hoping that they don't mess it up," said Ms. Short, who lives in this town about 70 miles northwest of Philadelphia.
Ms. Short is not dealing with her corner drugstore but with a so-called specialty pharmacy, a new breed of drug dispensary that has arisen to handle the exploding number of medicines that cost tens or hundreds of thousands of dollars a year and are used to treat complex or rare diseases like cancer, rheumatoid arthritis, hemophilia and H.I.V.
Such specialty medications, as they are called, now account for one-third of all spending on drugs in the United States, up from 19 percent in 2004 and heading toward 50 percent in the next 10 years, according to IMS Health, which tracks prescriptions.
Experts said that the warning reflected the gathering evidence that there was risk even in small amounts of the drug, so-called nonaspirin, nonsteroidal anti-inflammatory drugs, or Nsaids, and that everyone taking them should use them sparingly for brief periods. Millions of Americans take them.
"One of the underlying messages for this warning has to be there are no completely safe pain relievers, period," said Bruce Lambert, director of the Center for Communication and Health at Northwestern University, who specializes in drug safety communication.
But the broader context is important. The relative risk of heart attack and stroke from the drugs is still far smaller than the risk from smoking, having uncontrolled high blood pressure or being obese. At the same time, use of the drugs by someone with those other habits and conditions could compound the risk.
"The additional risk is relatively small, but it could be the straw that breaks the camel's back for someone already at risk," Professor Lambert said. The evidence that the drugs increase the risk of heart attack, stroke and heart failure "is now extremely solid," he said.
Tuesday, July 14, 2015
"Any numbness?" asked Joel Salinas, a soft-spoken doctor in the Harvard Neurology Residency Program, a red-tipped reflex hammer in his doctor's coat pocket. "Like it feels funny?" Josh did not answer. Salinas pulled up a blanket, revealing Josh's atrophied legs. He thumped Josh's left leg with the reflex hammer. Again, Josh barely reacted. But Salinas felt something: The thump against Josh's left knee registered on Salinas's own left knee as a tingly tap. Not just a thought of what the thump might feel like, but a distinct physical sensation.
That's because Salinas himself has a rare medical condition, one that stands in marked contrast to his patients': While Josh appeared unresponsive even to his own sensations, Salinas is peculiarly attuned to the sensations of others. If he sees someone slapped across the cheek, Salinas feels a hint of the slap against his own cheek. A pinch on a stranger's right arm might become a tickle on his own. "If a person is touched, I feel it, and then I recognize that it's touch," Salinas says.
The bubbly retired secretary had been in a minor car accident weeks earlier. She didn't worry much about her sore neck until a scan detected a broken bone.
The operation she needed, a spinal fusion, is done tens of thousands of times a year without incident. Stiles, 71, had a choice of three specially trained surgeons at Citrus Memorial, which was rated among the top 100 nationally for spinal procedures.
She had no way of knowing how much was riding on her decision. The doctor she chose, Constantine Toumbis, had one of the highest rates of complications in the country for spinal fusions. The other two doctors had rates among the lowest for postoperative problems like infections and internal bleeding.
It's conventional wisdom that there are "good" and "bad" hospitals — and that selecting a good one can protect patients from the kinds of medical errors that injure or kill hundreds of thousands of Americans each year.
But a ProPublica analysis of Medicare data found that, when it comes to elective operations, it is much more important to pick the right surgeon.
Today, we are making public the complication rates of nearly 17,000 surgeons nationwide. Patients will be able to weigh surgeons' past performance as they make what can be a life-and-death decision. Doctors themselves can see where they stand relative to their peers.
The numbers show that the stark differences that Stiles confronted at Citrus Memorial are commonplace across America. Yet many hospitals don't track the complication rates of individual surgeons and use that data to force improvements. And neither does the government.
A small share of doctors, 11 percent, accounted for about 25 percent of the complications. Hundreds of surgeons across the country had rates double and triple the national average. Every day, surgeons with the highest complication rates in our analysis are performing operations in hospitals nationwide.
Subpar performers work even at academic medical centers considered among the nation's best.
A surgeon with one of the nation's highest complication rates for prostate removals in our analysis operates at Baltimore's Johns Hopkins Hospital, a national powerhouse known for its research on patient safety. He alone had more complications than all 10 of his colleagues combined — though they performed nine times as many of the same procedures.
By contrast, some of the nation's best results for knee replacements were turned in by a surgeon at a small-town clinic in Alabama who insists on personally handling even the most menial aspects of each patient's surgery and follow-up care.
Surgeons around the country are now scored against their peers in a new statistic developed by a non-profit news organization that goes beyond hospital-level data, providing a never-before-available tool for consumers and generating debate and some angst in the surgical community.
Nearly 17,000 doctors performing low-risk, common elective procedures such as gallbladder removal and hip replacements are measured in the new calculation, which the non-profit news outlet
"It's long overdue," said Charles Mick, a spine surgeon in Massachusetts who advised on the project. "Consider baseball, if you're a batter but never knew if you hit the pitch, how could know you know if you're getting better?"
Not all surgeons will be happy seeing their names online with a higher-than-average complication rate — based on problems like infections, clots or sepsis that call for post-operative care. But the model also factors various risks a surgeon encounters, and adjusts the complication rates based on patients' ages, the quality of the hospital where the surgery took place, and other factors.
Monday, July 13, 2015
When Loren Peters arrived in the emergency room in October 2013, bruises covered his frail body and blood oozed from his gums.
The 85-year-old had not been in a fight or fallen down. Instead, he had been given too much of a popular, decades-old blood thinner that, unmonitored, can turn from a lifesaver into a killer.
"My goodness, I've never seen anything like it," recalled Lorna Finch, Peters's daughter, of the ugly purple bruise that sprawled from the middle of her father's stomach to his hip. "It was just awful."
Peters took Coumadin at his Marshalltown, Iowa, nursing home because he had an abnormal heart rhythm, which increases the risk of stroke. It's a common precaution, but the drug must be carefully calibrated: too much, and you can bleed uncontrollably; too little, and you can develop life-threatening clots.
When nursing homes fail to maintain this delicate balance, it puts patients in danger. From 2011 to 2014, at least 165 nursing home residents were hospitalized or died after errors involving Coumadin or its generic version, warfarin, a ProPublica analysis of government inspection reports shows. Studies suggest there are thousands more injuries every year that are never investigated by the government.
Sunday, July 12, 2015
How women could know they have cervical cancer before they even go to the doctor - The Washington Post
In a new research paper published in BMJ Open, we tried to understand how women notice and make sense of symptoms that might indicate a gynae cancer. There are five of these cancers, affecting the cervix, womb, ovary, vagina and vulva. They have a range of symptoms, many of which are common and can be a sign of much less serious conditions – things like bloating, bleeding between periods or after sex, and changes in bowel habits.
Here are some of the key signs and symptoms of cancer.
They are most likely to be caused by something much less serious than cancer, but they could be a sign of cancer.
Spotting cancer early is important as it means treatment is more likely to be successful. So it's important you tell your doctor if you notice anything on this list, or any other unusual or persistent change to your body. Although anyone can develop cancer, it's more common as we get older – around 9 out of 10 cases are in people aged 50 or over.
There are more than 200 different types of cancer, with many different symptoms. This list, in no special order, highlights the key ones to be aware of. But there's no need to learn symptoms – if you spot something that isn't normal for you, get it checked out.
Perhaps that's what makes my experience with Eaze, an on-demand weed delivery marketplace, all the more surreal. Last Friday while sitting in my friend's living room, I was able to get a preview of the company's new app-based feature, which allows users to consult with a doctor via their mobile phones or computers for medical marijuana assessments. Within an hour I used Eaze to video conference with a doctor, receive a marijuana recommendation and purchase an eighth of an ounce of "Sour Diesel" for delivery. The cannabis arrived shortly after the sausage and pepperoni pizza I had ordered to accompany it.
While diagnosing a patient using an internet video call and delivering marijuana to your front door are not particularly new advents, Eaze is hoping that combining the two will break open the legal U.S. cannabis market that did $2.7 billion in sales last year as estimated by ArcView Market Research, a marijuana investment and advocacy firm. In a time when everything from taxis to groceries have become "on-demand," the San Francisco-based company has raised $12.5 million in funding from investors including DCM Ventures, Snoop Dogg and Fresh VC to streamline the cannabis delivery market and lead the way in the budding weed startup economy.