This blog is a way of sharing the information and resources that have helped me to recover my son Roo from an Autism Spectrum Disorder. What I have learned is to view our symptoms as the results of underlying biological cause, which can be identified and healed. I say "our symptoms" because I also have a neuro-immune disorder called Myalgic Encephalomyelitis.

And, of course, I am not a doctor (although I have been known to impersonate one while doing imaginative play with my son)- this is just our story and information that has been helpful or interesting to us. I hope it is helpful and interesting to you!


Sunday, February 26, 2017

Is the American Healthcare System Really the Best? (spoiler- no)

In the US, we pay more for our medical care compared to every other country, yet we as a nation keep getting sicker. We have higher rates of many diseases than countries that spend just a fraction of what we do on medical care. The infant mortality rate in the US is embarrassingly high- we rank lower than many third world nations. Something is deeply wrong at the heart of this system- well, many things, on pretty much every level. People are getting sicker, many patients have complex health issues that often go undiagnosed and untreated for years, doctors and other medical personnel are burned out. Many "new" diseases are being "discovered", known diseases that were once rare are becoming more common, and for those of us in this boat it is especially obvious that this medical system is not set up to handle any of this.  I would say that at the core of these problems is a lack of humility and accountability.  Patients often find themselves stuck in a system that discounts and dismisses what they say and prefers to lecture and moralize them as if they were naughty children. When a patient fails to instantly become well again simply by being honored with the doctor's presence, the blame is placed entirely on them.  This satirical headline sums it up-
How to Get Your Doctor to Believe You by Dying in Front of Them

See also this post: Problems with Clinical Research and Peer Review

The Big Picture:
The Truth about why Doctors and Nurses are leaving!
This is about the British nationalized health care system but the concerns are pretty much the same in the US.  There are systemic problems involving burnout and bad working conditions including endemic racism and prejudice, career politics, inadequate pay relative to similar level positions in other industries, intentional under-staffing and under-stocking supplies, placing profit above care, and administrative policies that are completely out of touch with the reality of hospital work and that undermine morale and staff effectiveness. 

Being American Is Bad for Your Health
"Americans under age 75 fare poorly among peer countries on most measures of health. This health disadvantage is particularly striking given the wealth and assets of the United States and the country's enormous level of per capita spending on health care, which far exceeds that of any other country."

Living Sick and Dying Young in Rich America
"But it’s not just that Americans are getting sicker—it’s that young Americans are getting sicker. A 2013 report by the National Research Council and Institute of Medicine (NAC/IOM) echoes the shock of that fact. “The panel was struck by the gravity of its findings,” it reads. “For many years, Americans have been dying at younger ages than people in almost all other high income countries.”

Why American Healthcare Is The Worst In The Developed World
In America, healthcare costs are more than 16% of our GDP and we spend over $10 K per capita, and this doesn't cover everyone.  In 2018 27 million Americans didn't have health insurance.  America has more uninsured and under insured people than any of the other developed nations.  25% of people who do have insurance still have trouble paying their medical bills.  Americans pay extremely inflated prices for drugs, often by 10 times or more, even though those drugs were developed by taxpayers money (we paid for it).  

The American system of health insurance began back in the 1930s, when BlueCross and BlueShield were the two primary insurance companies.  They operated as non-profits and didn't turn people away.  Health insurance became something that is provided through an employer during WW2 as a benefit. In 1940 only about 10% of Americans had insurance and by 1955 the number had gone up to 60%.  During this time is when many private insurers entered the market.  America's first for-profit hospitals opened in the 1980s and the cost of medical care began to rise and become more complicated.  

Health outcomes in America now, after this transition, have gotten much worse.  We have the highest maternal and infant mortality rate of any developed country and our life expectancy is poor and getting worse.  We have worse access to doctors and medical care than other countries and higher rates of medical errors, so the quality of care that we get is not better due to our system, it's worse.  Some of the poor outcomes in the US are from the application of business strategies focused on profitability that were developed in other industries, but are not well-suited to health care.  An example of this is using "just in time" delivery of important supplies in order to save costs but at the risk of not having essential items, jeopardizing lives, which does happen.  

The reason we pay so much money for health care here is because that money goes towards profit, which means high salaries, high bonuses, high returns to investors, and other private entities rather than towards the cost of he care we receive.  We are one of the only countries that doesn't regulate the cost of drugs and other medical needs.  Another reason for our high costs and poor outcomes is that preventative care isn't profitable the way that acute and emergency care is.  

Mexico Is Taking Care Of America's Health Care Crisis

Singapore, Nordic countries outrank US in achieving UN health goals
"Singapore is at the top of the list, followed by Iceland, Sweden, Norway, the Netherlands, Finland, Israel, Malta, Switzerland and the UK. The United States trails these standout nations, landing in the 24th spot on the index."

Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016

The U.S. Health Care System: An International Perspective
"This fact sheet will compare the U.S. health care system to other advanced industrialized nations, with a focus on the problems of high health care costs and disparities in insurance coverage in the U.S. It will then outline some common methods used in other countries to lower health care costs, examine the German health care system as a model for non-centralized universal care, and put the quality of U.S. health care in an international context."

"The OECD found that in 2013, the U.S. spent $8,713 per person or 16.4 percent of its GDP on health care—far higher than the OECD average of 8.9 percent per person. Following the U.S. were the Netherlands, which allocated 11.1 percent of its GDP, then Switzerland also at 11.1 percent, and Sweden, which allocated 11 percent of its GDP to health care in 2013. In North America, Canada and Mexico spent respectively 10.2 percent and 6.2 percent of their GDP on health care."

"On a per capita basis, the U.S. spends more than double the $3,453 average of all OECD countries."

U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes
"Health care spending, both per person and as a share of GDP, continues to be far higher in the United States than in other high-income countries. Yet the U.S. is the only country that doesn’t have universal health coverage.  The U.S. has the lowest life expectancy at birth, the highest death rates for avoidable or treatable conditions, the highest maternal and infant mortality, and among the highest suicide rates.  The U.S. has the highest rate of people with multiple chronic conditions and an obesity rate nearly twice the OECD average.  Americans see physicians less often than people in most other countries and have among the lowest rate of practicing physicians and hospital beds per 1,000 population.  Health spending per person in the U.S. was nearly two times higher than in the closest country, Germany, and four times higher than in South Korea.  In 2021, 8.6 percent of the U.S. population was uninsured.8 The U.S. is the only high-income country where a substantial portion of the population lacks any form of health insurance."

The US Health Disadvantage Relative to Other High-Income Countries: Findings From a National Research Council/Institute of Medicine Report
"The United States spends more on health care than does any other country, but its health outcomes are generally worse than those of other wealthy nations. People in the United States experience higher rates of disease and injury and die earlier than people in other high-income countries. Although this health disadvantage has been increasing for decades, its scale is only now becoming more apparent."

"The scope of the US health disadvantage is pervasive and involves more than life expectancy: the United States ranks at or near the bottom in both prevalence and mortality for multiple diseases, risk factors, and injuries."

Shorter Lives, Poorer Health: Panel on Understanding Cross-National Health Differences Among High-Income Countries
(This is the report made by National Research Council and The Institute of Medicine that is referenced in the articles above.)

Medical Errors: The Silent Killer in Medicine | Carol Gunn | TEDxFargo

Without Question (from the Perspective section of the NEJM)
"Cognitive diagnostic errors remain extremely common, accounting for up to 70% of all medical errors. The role of these errors in increasing morbidity and mortality is now recognized, and efforts are being made to improve the teaching of critical thinking in medical training and to make physicians aware of cognitive biases and other issues that can increase the risk of diagnostic error.

However, even in the era of electronic medical records, clinicians often meet new patients without having access to the primary data that were used to establish their diagnosis. In such instances, the physician must decide whether or not to accept at face value each part of the reported medical history. For some diagnoses, it may simply be practical and reasonable to trust the records, but physicians promulgate at the patient’s peril any previous diagnosis that they accept blindly."

Hospital: We Can't Deliver Babies Anymore Because of Abortion Ban

Bias, Prejudice, Negligence and Abuse of Patients:
The US medical system is still haunted by slavery

Family of Henrietta Lacks Files Lawsuit over Use of Stolen Cells, Lambasts Racist Medical System

Doctor works to end amputation epidemic among Black Americans in Mississippi

California hospital facing investigation over treatment of Black women in childbirth
In 2021, the maternal mortality rate for black women was 2.6 times higher than the rate for white women.

The Death of Daniel Prude — Reflections of a Black Neurosurgeon
"Deaths in police custody continue to be attributed to “excited delirium,” a condition that is not recognized by the American Psychiatric Association or the American Medical Association. Described as a stress response to over stimulation of dopamine and NMDA receptors, leading to cardiac arrest, it is used disproportionately to justify the deaths of Black and Brown victims of police brutality. But death by suffocation is not excited delirium. We need a cultural shift to the expectation that deaths occurring at the hands of police are independently investigated."

A Call for Antiracist Action (New England Journal of Medicine)

Bias In Medicine: Last Week Tonight with John Oliver (HBO)

Dr Susan Moore Last Words Before Dying From COVID and Neglect

Ms. Omega One
"There was no news report. I looked every day for a week. The patient’s death never made headlines. It wasn’t on the front page. It wasn’t even on the back page. If you Google her real name, all you will find are the time and location for her wake and funeral. You will learn nothing about this young mother and how much the loss of her young life cost her family and community. You won’t read about the ripple effects of such a tragedy on society. Decisions about what is and what is not newsworthy reflect societal norms, and the lack of news coverage of the death of Ms. Omega One attests to our society’s implicit value judgment. It says that the loss of Ms. Omega One is not as great as the loss of other people, that her life didn’t matter.

More than 100 people in the United States die each day from gun violence. The majority of these deaths occur in Black and Brown communities. Black people killed in Black neighborhoods are the least likely to receive media attention and, even when they do, they are less likely than White people to be described as complex human beings, and their death is less likely to be described as a loss to the community. According to these data, had Ms. Omega One been a White woman killed in a White neighborhood, her death would have been substantially more newsworthy. She would have been described as a person linked to other people — a mother, a daughter, a sister, or maybe a mentor. She might have been described as creative, brave, or a talented athlete. Had she been a White woman killed in a Black neighborhood, her death would have been deemed even more newsworthy.

But she wasn’t. I would love to tell you about her complex humanity and what a significant loss her death was to her family and her community, but I can’t. I know nothing about her, because her death was not deemed newsworthy. But I do know that a family in Baltimore feels her loss every day. I know that a young girl is now preparing for kindergarten and that her mother is not there to get her on the bus. I know that this child is statistically more likely to suffer from many psychosocial problems because of the circumstances of her infancy. I know that there is anger in our society about situations just like this one. And I know that, until we decide that the death of Ms. Omega One is as great a loss as every other death in the United States, we will not become the society that we wish to be."

Doctor Loses Job After EXPOSING What Hospitals Do To Pregnant Black Women

Mother's infant decapitated during childbirth: Lawsuit

#WhiteCoatsForBlackLives — Addressing Physicians’ Complicity in Criminalizing Communities

Seeking justice in maternity care mistreatment
This news report presents a CDC report about widespread physical, verbal, and emotional abuse of women while giving birth, which has sometimes resulted in injuries and serious trauma.  Examples cited in the report include women being denied privacy, being verbally abused by shouting or scolding, refusal of help when requested, women being forced to undergo procedures and treatments not only without consent but with denial, women being threatened if they do or don't consent to an intervention.  There has been a rise in recent years in maternal deaths, especially in black and Hispanic women. 

The Surgery That Should've Never Happened | The Tragic Case of Michael Skolnik
Michael Skolnik was a young man who was found to have a colloid cyst in his brain.  The neurosurgeon who performed surgery on him lied to overstate his expertise and experience and dramatically botched several surgeries in a row that caused severe harm including brain damage, severe chronic neuropathic pain, grand mal seizures, severely compromised immune system, and more.  The first brain surgery he performed bedside rather than in an OR with a hand drill.  He had Michael sign consent forms for the second surgery while under the effects of very heavy sedation and opioids.  It has been established that Michael's cyst was actually benign and did not require such invasive surgery, and that the "gold standard" first line surgery for this issue is a small laparoscopic surgery that was never even mentioned to Michael's family.  Michael's parents found out after Michael's death (from complications) that the surgeon had multiple malpractice suits against him in multiple states.  It appears that the other staff at the hospital covered up for this surgeon.  Michael's parents went on to focus on patient advocacy, got a law passed in Colorado requiring that information about a doctor's record including malpractice cases and criminal convictions be made public, and filed a malpractice case themselves.  Despite everything, a board examiner found that there was no wrongdoing in this case, so they settled their malpractice case out of court. 

My Son Has Autism.  Discrimination Almost Cost Him His Life.
"Five years ago, when my son Lief was 9, he fell ill with a virus. The virus attacked his heart and flooded it with fluid. The pressure from the growing pool inside his heart tore the muscle fibers. In a matter of weeks, he was transformed from a healthy kid to a critically ill hospital patient with only one hope for survival: a heart transplant.

Because of our son’s disability, the doctors at our local children’s hospital told us that no facility would perform the transplant, and we should prepare for him to die. A second hospital also refused to consider him. As Lief’s condition swiftly deteriorated, one young physician pleaded Lief’s case to a third transplant hospital, and Lucile Packard Children’s Hospital at Stanford University opened its doors to us.

We were warned that Lief would not survive the flight from Portland, Ore., to California. As we flew through the night, Lief’s heart stopped again and again. When we arrived, he was outfitted with a standard “bridge therapy.” This cumbersome computer and heavy batteries that hang from outside the body had the power to extend his life by years. The device is used by 7,000 children and adults. Our local hospital had failed to make us aware that this therapy existed and could extend his life."
 
How Columbia Ignored Women, Undermined Prosecutors and Protected a Predator For More Than 20 Years
An OB/GYN who has been on the faculty of Columbia's med school for decades, Dr Robert Hadden, was accused of assault by over 240 patients over the decades that he worked and taught there.  Warnings by patients, including one who called 911 leading to his arrest, were ignored and he was allowed to continue to practice. 

What Did Columbia Know? Survivors of Convicted Sex Abuser Robert Hadden Demand Full Accountability
This is an update- Hadden was convicted on federal sexual abuse charges and sentenced to 20 years in prison.  His conviction was for luring patients across state lines in order to sexually assault them.  The judge said the case was unprecedented due to the hundreds of victims and the fact that it occured for more than two decades.  The prosecutor called Hadden "a predator in a white coat".  Columbia University, who employed Hadden during this time and was aware of complaints from patients and of his first conviction, still insists that it has no responsibility to notify his former patients.  Columbia and New York Presbyterian Hospital have paid over $100 million to over 250 former patients.  He pled guilty in 2016 to charges involving two women and lost his medical license but did not receive prion time or probation.  He was even arrested at one point when one of his patients called the police, and Columbia did not inform any of his patients of the arrest and allowed him to continue seeing patients.  One of the survivors describes the grooming that he did (which was extensive) and the sexual assault he committed.  He saw an estimated 6 to 8 thousand patients during his career at Columbia

Women Are Dying Because Doctors Treat Us Like Men
"Studies have shown that female patients' symptoms are less likely to be taken seriously by doctors, and women are more likely to be misdiagnosed, have their symptoms go unrecognized, or be told what they're experiencing is psychosomatic. "It happens all the time," says Dr. Martha Gulati, head of cardiology at the University of Arizona College of Medicine, after hearing the details of Mirza's case. "If you're in health care and take care of a lot of women, you certainly hear these stories and shake your head, because you know what they're going to say, because you see it far too often, unfortunately. The bottom line is, we don't do as good of a job taking care of women as we do men." In the decade Mirza spent waiting for a proper diagnosis, her heart sustained damage that can never be undone. She has had a dozen heart surgeries, went into heart failure in 2013, and will almost assuredly need a transplant one day. "There is inherent bias that makes us undervalue women's symptoms," Gulati adds. "What [Mirza] experienced is a great example of the problem with us not recognizing women at risk—by the time we make a diagnosis, they are living with the consequences of the lack of care."
 
I Went Blind Before Doctors Believed Me | All In Her Head |

The invisible woman? The challenge at the doctor's office every woman needs to know about

Being a Good Girl Can Be Hazardous to Your Health
 
For people with disabilities, doctors are not always healers
"As with James, patients may have unnecessary tests ordered because of their disability. Doctors and nurses label this approach “veterinary medicine.” In other words, just as for an animal that can’t speak for itself, they order tests rather than talk to patients who are perceived as being “slow” or “difficult.” These patients often receive inadequate care: Either doctors can’t see past the disability and attribute all problems to it, or they fail to acknowledge the true impact of these impairments...
Numerous reports have documented that people with disabilities have poorer health and receive inferior health care."
 
The Danger of Treating ER Patients as Drug Seekers
"Recently the news has been covering the story of Barbara Dawson, a Florida woman who was arrested after she refused to leave a hospital that would not treat her for abdominal pain. While being escorted from the hospital in handcuffs, she collapsed in the parking lot and later died."
 
‘It’s like I’m worthless’: Troubleshooters investigate patient dumping allegations
This local news report from Louisville KY shows scenes and discusses cases in which sick patients were wheeled out of the hospital and dumped on the curb outside with nowhere to go.  Some were literally dumped on the ground, including elderly and disabled/paralyzed patients, while others were driven and left or led away by security.  This happens many times a year in just this one city and is happening in many other cities as well.
 

He went to the hospital for help. He left on his hands and knees.

Hospital staffers took photos of an unconscious patient’s genitals and shared them
 

Systemic Problems (shortages, incompetence, greed, etc)
Two cardiac surgeons fired from Adena Health
A cardiac surgery program has been suspended following a review that was done after a number of patient deaths from apparent incompetence of the surgeons involved. 

The FDA keeps an updated list of drug shortages and has an app that can notify you about them.

Drug Shortages Forcing Hard Decisions on Rationing Treatments
"In recent years, shortages of all sorts of drugs — anesthetics, painkillers,antibiotics, cancer treatments — have become the new normal in American medicine. The American Society of Health-System Pharmacists currently lists inadequate supplies of more than 150 drugs and therapeutics, for reasons ranging from manufacturing problems to federal safety crackdowns to drug makers abandoning low-profit products. But while such shortages have periodically drawn attention, the 
rationing that results from them has been largely hidden from patients and the public."
 
 
 
The Breakdown in Biomedical Research
"Contaminated samples, faulty studies and inadequate training have created a crisis in laboratories and industry, slowing the quest for new treatments and cures"
 
National Practitioner Data Bank
national database that tracks problem doctors.
Congress created the national clearinghouse in 1986 to prevent problem medical workers from crossing state lines to escape their pasts and keep practicing.
 
Evidence of the Superiority of Female Doctors
Not all medical care is equal in quality, and steps could be taken to improve the quality of doctor care, which would limit mortality and morbidity.
 
Rural Medicine Transfers a Patient
This is done as a parody, but it actually communicates very well the serious lack of necessary medical services and resources in rural places.  This is a systemic problem in the US that reflects a lot of problems including the basically for-profit medical system and the level of debt that many doctors have from medical school.  This problem really needs to be addressed because it is harming a lot of people.

VA conceals shoddy care and health workers' mistakes
"In 88 cases, the VA concluded, Franchini made mistakes that harmed veterans at the Togus hospital in Maine. The findings reached the highest levels of the agency. "We found that he was a dangerous surgeon," former hospital surgery chief Robert Sampson said during a deposition in an ongoing federal lawsuit against the VA. Agency officials didn’t fire Franchini or report him to a national database that tracks problem doctors. They let him quietly resign and move on to private practice, then failed for years to disclose his past to his patients and state regulators who licensed him.

In other cases, veterans’ hospitals signed secret settlement deals with dozens of doctors, nurses and health care workers that included promises to conceal serious mistakes... In at least 126 cases, the VA initially found the workers’ mistakes or misdeeds were so serious that they should be fired. In nearly three-quarters of those settlements, the VA agreed to purge negative records from personnel files or give neutral or positive references to prospective employers. In denying requests for information, the agency cited federal privacy law and said protecting employees’ privacy outweighed the public’s right to know about problems involving veterans’ care."
 
 
 
Oozing beds discovered at Tacoma hospital | FOX 13 Seattle

How ADHD Treatment Is Not ADHD Friendly

Revealed: Thousands dying in hospitals because patients cannot be discharged 

Charlotte's Story: Untreated B12 Deficiency
This is the story of a British woman who presented many times to various doctors with joint problems, extreme weight loss, serious neurological symptoms such as numbness from the waist down, and was repeatedly blown off and told that the symptoms were due to anxiety and depression.  Eventually her test results were so distressing that she spent over 2 weeks in the hospital only to find it was severe B12 deficiency.  Her diagnosis was so delayed that she has permanent spinal damage and is wheelchair bound when she would have had no long term consequences had she been properly diagnosed and treated.  This took away her life for 8 years.

The System is Also Not Working Well for Many Doctors and Other HCPs
Why Are Doctors Quitting? This Physician Says They Are Demoralized | Amanpour and Company
Interview with Eric Reinhart, a political anthropologist and medical doctor, discussing his recent article in The New York Times in which he argues that the current exodus of doctors from the American medical system is from being demoralized, not burnout.  He is saying that the factors contributing to burnout have been present for a long time, but that the pandemic highlighted for many doctors that the system is broken and they are not helping their patients the way they want to.  He points out that we have the highest paid doctors in the world but these doctors work in the least effective medical system in the developed world.  Recently a study in a medical journal showed that 338,000 American lives could have been saved during the pandemic if we had had universal healthcare.  He refers to these deaths as "bureaucratically ordained" because the systems that led to them were specifically designed that way to be profitable to certain people.  He says that for many people in the healthcare field, watching these unnecessary deaths occur over and over resulted in a loss of the narrative that they have about their field, that the work they do is part of a moral structure, he calls this a loss of ideology.  He says the medical system is entirely inconsistent with the values it claims to have of health equity, improving human life, but instead it is set up to maximize profit.

The tradition of social medicine was developed by a German pathologist named Rudolph Feirkau, who studied a typhus epidemic and realized that what mattered wasn't his medical knowledge, it was factors such as housing and labor conditions that determined health.  Dr Reinhart is saying here that policy decisions, which are political, are what determine health outcomes in the US but the medical profession has been ignoring that.  Every system, including the medical system, needs to be accountable for the effects that it has whether or not they are intentional.  "Ethics without a paired politics to advance the ideals you claim to subscribe to, is largely meaningless.  In many ways it's worse than nothing."  While the ACA did expand access to healthcare, it did not make it universal, there are still 30 million Americans who do not have health insurance.  Many people who do have insurance are underinsured.  Having an insurance card does not necessarily mean good care.  The ACA functions in the same context as our system always has, and has led to even higher profits for private insurance companies and for pharma companies.  During the pandemic, many hospitals and other medical-sector companies made record profits while hundreds of thousands of people died who didn't have to.  The goals of the system are completely separate from "health care".  

The history of medicine, including the rise of the AMA, put certain systems in place to serve doctors not patients.  Part of this was putting in place protections for doctors from demonized socialized medicine.  The people behind this knew it would harm patient outcomes but did it to protect the status and pay of doctors.  Public health, and its preventative systems, are the true basis for health in a society, not "health care".  He says that doctors are not necessarily experts in public health, and the medical treatment part of total health that they contribute is only between 10 and 20 percent, meaning that 80 to 90% of the relevant knowledge for public health does not come from the medical field.  Other fields, such as communications, labor studies/economics, environmental sciences, all have important contributions to make.  Also, the people in marginalized communities with limited or no access to health systems know what they need and know how to make it from the bottom up.  He says that all effective public health structures are built bottom up.   

The interviewer points out that black doctors have been saying these things for a long time.  In fact, they were excluded from participating in the AMA so they formed the National Medical Association.  She asks why these doctors weren't listened to?  His response was to emphasize again the need for all medical systems, including the systems created by and for doctors, to be built bottom up so as to guarantee inclusivity.  Doctors who have been excluded in the past have a lot to contribute that will upend the current power structures, while it's easier for those power structures to absorb progressive doctors and silence them.  One suggestion that he has is for doctors to form unions, and that they form these and other organizations with other health care workers such as techs and nurses, even with their patients and their communities.  This would have them moving away from being allied with the powerful institutions that they work for such as hospitals.  Their is a cultural story of the heroic doctor who saves patients by working hard or fighting the system, but in reality this vision isn't helpful.  Doctors will be much more successful working together and with their communities than as individuals.  Che Guevara, who had trained as a doctor, said that he had moved from a position of the heroic doctor to a vision that a society that cares for itself would be truly revolutionary.   
 
Miller Philosophical, Blunt, Calls for Systemic Change
"Why is medicine no longer a noble profession?” he said to a capacity crowd. “If you don’t like what I have to say, you are welcome to leave, but … we must do this for our patients.” A self-described individualist with rightwing roots, Dr. Miller said a single-payer system, similar to that used in Great Britain, will force doctors to improve the quality of care they are providing their patients.“I started off as a far right-wing Goldwater supporter and I may leave this world a socialist,” he said. “It is the god damnedest thing I’ve ever seen. This is hard, …we don’t want regulations, but perhaps we need them.

The inverted incentives that doom the current system to failure are a good example of external forces that need be eradicated, Dr. Miller said. They (incentives) are perverse and they are certainly not sustainable,” he said. “If we adopted best practices throughout the country, one-third of the health care practitioners in the country would be fired and would have to be retrained."
 
Let Doctors Be Doctors
There is starting to be a movement by doctors and other health care personnel to move away from the intensive use of EHR (electronic health records) , particularly in settings such as the ER in which the need to keep up with the EHR can be dangerously distracting for providers.  There are many other reasons why this is an issue, and they are covered in a funny parody song by ZDoggMD (a med student, possible doctor now, and the founder of the Let Doctors Be Doctors movement (he also does a mean Darth Vader as Doc Vader). 
 
Doctors unionize as healthcare services are consolidated into corporate systems
As the medical system restructures itself, doctors are finding themselves working in worsening conditions including longer hours, more paperwork, and less time with patients to provide the care they want to.  Some doctors are unionizing to try to change this and improve their own working conditions as well as the quality of services that they provide. 



 

Why Doctors Kill Themselves TED talk

Patient Care Can Be Compromised by the Involvement of Other Systems
How a cyberattack crippled the U.S. health care system
Change Healthcare, owned by UnitedHealth, was hacked in a cyber attack that shut down a payment processing system used throughout the US health care system.  This is being called the worst ever such attack on the US health care system.  This has meant that pharmacies have been not getting prescriptions, doctors and hospitals aren't getting payments they need to function, and some patients aren't getting insurance approvals for needed treatments.  The department of health and human services has offered some limited help but it's not enough to keep this from having a major impact on the system's ability to function in even a basic sense.  Even though Change may have paid a ransom already, it's still very challenging to repair the damage that was done so there is no end in sight for the problems caused by this cyber hack.  This attack and its aftermath highlight a lot of the problems that result from the way the healthcare system in the US is structured, including consolidation. 

Utah Attorney General grants forgiveness after 'Rape Hospital' investigation
This case also falls under the category of "abuse of patients".  Multiple patients, including minors and adults, have been assaulted and raped at this facility in a pattern that the AG's office called "habitual".  The CEO stated that he did not have enough staff to keep the patients safe.  Patients are routinely kept in unsafe conditions.  The AG's office did an investigation that found al of this, but only one person (one staff member) was charged with a minor charge (failure to report abuse) and was allowed to have the charges dropped for paying a fee of $690.
 
Utah Department of Health justifies not shutting down ‘The Rape Hospital’
Every year there have been reports of assaults and rapes, with investigations by police, the health department, the AG's office, and yet somehow this hospital is still functioning (at the time of this information).  It's license to function has been taken and replaced with a conditional license three times.  The Utah Department of Health and Human Services has never shut down a psychiatric facility.  The hospital would appease the system by promising to retrain staff, but employess say that this would mean signing papers.  They are understaffed. 
 
Martin Shkreli Is Found Guilty of Fraud This is a case of fraud that was bigger than just medical issues, but it did involve a shell pharmaceutical company and sheds some light on how corporations involved in the medical field can be affected by larger-scale fraud in the financial sector.  
 
Are clinical practice and public health policies actually supported by current evidence?
The Four Most Dangerous Words? "A New Study Shows"
This talk, given by philanthropist Laura Arnold, is about how much programs and policies meant to help people (anything from medical treatment to reading programs to job training programs) are not based on sound evidence, and when subjected to rigorous scientific study, are found to be worthless at best and harmful at worst.  She makes the point that since millions of dollars are spent on such programs each year we need to know what works and what doesn't so that the money can go to support programs that actually work.  She talks a bit about the culture around research, publication, and policy-making that has led to this situation.

"For all the truly wondrous developments of modern medicine—imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments, to name a few—it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable—or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades."

 
Fraud, Crime, Corruption, Conflicts of Interest, and Ethics Violations
Family of Anaheim teacher sounds alarm on bone material used in surgeries
A woman died from tubercular meningitis after receiving a bone product during a surgery for scoliosis that came from a cadaver that had been infected with tuberculosis.  The manufacturer of the bone product claims that batches are tested for safety, but somehow this contaminated bone was still used.  Several dozen other patients who received this product from the same lot also became sick, and at least one other patient also died.  There was a similar situation in 2021 when another contaminated batch of the bone product caused 8 deaths and nearly 100 people to become seriously sick.  The company has changed its name from Aziyo to Elutia and there is no information about Elutia that lets people know that it is the same company that is responsible for these two outbreaks and the resulting illnesses and deaths.  Patients considering surgeries that can include bone products like this are not informed about the real risks and the information is kept hidden from them, even if they look for it.  

 
 
Queens doctor accused of drugging women and video recording rapes
While the business in question here may not be an established part of the American medical system, it was involved in at least a more peripheral way, and I believe this case is very relevant when considering profound failures within that system.  
 

Confessions of an FBI Agent HUNTING Murder Doctors | Agent Bruce Sackman
There are serial killers who are doctors and nurses, some working in hospital settings.  They tend to have many more victims than an average serial killer (60 victims on average compared to 7 or 8 victims for other serial killers).  Part of the problem is that it's easier to hide murders in a hospital for several reasons, including that the murder scene is scrubbed clean after the death and death is less surprising and suspicious in a hospital.  The biggest problem seems to be that hospitals have every incentive to cover up the killings because of how badly publicity could harm the reputation and trust the community has in the hospital.  Because of this, doctors and nurses suspected of killing patients are often quietly moved to other facilities where they continue to harm and kill patients.
 
Medical Costs and Insurance
"A group of major American hospitals, battered by price spikes on old drugs and long-lasting shortages of critical medicines, has launched a mission-driven, not-for-profit generic drug company, Civica Rx, to take some control over the drug supply.
Backed by seven large health systems and three philanthropic groups, the new venture will be led by an industry insider who refuses to draw a salary. The company will focus initially on establishing price transparency and stable supplies for 14 generic drugs used in hospitals, without pressure from shareholders to issue dividends or push a stock price higher."
The U.S. health care system is full of monopolies
"The U.S. spends more than any other industrialized country for health care, largely because our prices are higher. And the monopolies that support those high prices could undermine both liberal and conservative dreams of a more efficient system.  This is a trend that's happening at every level.  “America’s health care crisis is brought you by monopoly,” Open Markets policy director Phil Longman said."
Why the U.S. pays more for health care than the rest of the world (Piece by NPR)
 
 
'Barbaric' System Saddles Over 100 Million in US With Healthcare Debt
"More than 100 million people in America--including 41% of adults--beset by a healthcare system that is systematically pushing patients into debt on a mass scale," the investigation found. "A quarter of adults with healthcare debt owe more than $5,000. And about one in five with any amount of debt said they don't expect to ever pay it off."

Dr. Rishi Manchanda, the CEO of Health Begins, told KHN that "debt is no longer just a bug in our system."

"It is one of the main products," Manchanda added. "We have a health care system almost perfectly designed to create debt."

Our daughter was born with half-a-heart. Instead of treatment, Cigna has put our family through insurance nightmare.

The Americans dying because they can't afford medical care
"A December 2019 poll conducted by Gallup found 25% of Americans say they or a family member have delayed medical treatment for a serious illness due to the costs of care, and an additional 8% report delaying medical treatment for less serious illnesses."
 
 
Will losing health insurance mean more US deaths? Experts say yes
"The researchers calculated that in 2005, lack of health insurance resulted in 44,789 deaths of Americans age 18 to 64."  A 2002 study published by the Institute of Medicine found that 18,000 people died each year due to lack of health insurance. A study published by the Urban Institute put the figure at 22,000 deaths in 2006."  These numbers are estimates and hard to know how accurate they are.  

Medical Crowdfunding and Disparities in Health Care Access in the United States, 2016‒2020
"Despite its popularity and portrayals as an ad-hoc safety net, medical crowdfunding is misaligned with key indicators of health financing needs in the United States. It is best positioned to help in populations that need it the least."

Are Things Changing?

What Veterinarians Know That Physicians Don't
This is a TED talk given by Barbara Natterson-Horowitz (Professor of Medicine in the Division of Cardiology at UCLA Medical School), in which she argues that human medical treatment could be improved if doctors thought of patients as "human animals".  She argues that while animal bodies are can be very different from each other, thinking in terms of similarities could open up many options and treatments that are routinely used on animals but no one ever thought to try for humans.  This change in paradigm may not be so easy to manifest, as there is a rampant culture of "human exceptionalism" in conventional medicine and a corresponding arrogance on the part of MDs that can interfere with doctors providing the best care.

IBM's Watson learning to diagnose cancer


Posted by at
Labels: