See also this post: Problems with Clinical Research and Peer Review
The Big Picture:
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.”
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.)
Bias, Prejudice, and Abuse of Patients:
Leana Wen: What your doctor won’t disclose
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.
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."
Women Are Dying Because Doctors Treat Us Like Men
Being a Good Girl Can Be Hazardous to Your Health
We Cannot Continue to Let Doctors 'Gaslight' Chronic Illness Patients
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."
Detroit EMT fired for refusing to help save distressed 8-month-old baby that died next day
Hospital staffers took photos of an unconscious patient’s genitals and shared them
Ohio State has more than 100 firsthand accounts of sexual misconduct by former athletic doctor
Systemic Problems (shortages, incompetence, etc)
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."
FDA approves first generic version of EpiPen
version out of self interest.
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.
Not Good: Nearly 1 in 3 Drugs Have Safety Issues Even After FDA Approval
"New research has shown that, even after drugs are approved by the US Food and Drug Administration (FDA), nearly one in three of them go on to have safety issues. That's not necessarily as bad as it sounds - the good news is that this shows the FDA is taking lifetime monitoring of its approved drugs seriously. But perhaps more concerning is the fact that so many drugs with safety issues are getting approved in the first place."
French company bungled clinical trial that led to a death and illness, report says
"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."
The Breakdown in Biomedical Research
‘Ain’t nobody got time for this’: 911 dispatcher sentenced to jail after hanging up on thousands of callers
Cincinnati officers searching for teen crushed in van never got out of cruiser
A doctor with a chronic health condition describes just how hard it can be to get a routine prescription filled for a long-term medication.
Bacteria infected 10 infants at UC Irvine hospital, but the public is just finding out
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.
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).
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."
Patient Care Can Be Compromised by The Involvement of Other Systems
Fallout continues for detective who assaulted a nurse, and why there may be a lot more to this story
Are clinical practice and public health policies actually supported by current evidence?
The Corruption of Evidence Based Medicine — Killing for Profit
"This has huge implications. Evidence based medicine is completely worthless if the evidence base is false or corrupted. It’s like building a wooden house knowing the wood is termite infested. What caused this sorry state of affairs? Well, Dr. Relman another former editor in chief of the NEJM said this in 2002 “The medical profession is being bought by the pharmaceutical industry, not only in terms of the practice of medicine, but also in terms of teaching and research. The academic institutions of this country are allowing themselves to be the paid agents of the pharmaceutical industry. I think it’s disgraceful”
The people in charge of the system — the editors of the most important medical journals in the world, gradually learn over a few decades that their life’s work is being slowly and steadily corrupted. Physicians and universities have allowed themselves to be bribed."
The Four Most Dangerous Words? "A New Study Shows"
Dangers and side effects from treatment and medications
Prescription Drugs Now Kill More People In The US Than Heroin And Cocaine Combined
When Half a Million Americans Died and Nobody Noticed (Vioxx)
Drug executives to testify before Congress about their role in U.S. opioid crisis
"Since 2000, the epidemic has killed 200,000 people — more than three times the number of U.S. military deaths in the Vietnam War."
"How well does a prescription drug work? It can be hard for even doctors to know. Pharmaceutical companies frequently withhold the results of negative or inconclusive trials. Without a full accounting, a physician who wants to counsel a patient about whether a drug works better than a sugar pill is frequently at a loss. Drug companies share only airbrushed versions of data on safety and usefulness.
As a consequence, regulators can approve drugs that have hidden health hazards. Clinical trials of GlaxoSmithKline's diabetes drug Avandia (rosiglitazone) and Merck's anti-inflammatory Vioxx (rofecoxib) revealed an elevated cardiac risk from the drugs, but relevant findings were held back from regulators or never published.* Far more drugs have gone to market with critical safety data kept secret. These scandals have tarnished the reputation of the pharmaceutical industry."
Transparency in medicine Dr Wen
Pharmaceutical advertisements in leading medical journals: experts' assessments.
"In the opinion of the reviewers, many advertisements contained deficiencies in areas in which the FDA has established explicit standards of quality. New strategies are needed to ensure that advertisements comply with standards intended to promote proper use of the products and to protect the consumer."
Accuracy of pharmaceutical advertisements in medical journals.
"Doctors should be cautious in assessment of advertisements that claim a drug has greater efficacy, safety, or convenience, even though these claims are accompanied by bibliographical references to randomized clinical trials published in reputable medical journals and seem to be evidence-based."
Fraud, Conflicts of Interest, and Ethics Violations
Conflicts of interest pervade US treatment guidelines, reports say
Oncology trial authors don’t fully disclose financial conflicts of interests, analysis finds
Leading US cancer researcher failed to disclose industry ties in dozens of articles
"One of America’s most prominent breast cancer doctors failed to disclose pharmaceutical industry ties worth millions of dollars in authoring dozens of articles in major journals, according to a report by the New York Times and ProPublica. José Baselga, physician-in-chief at Memorial Sloan Kettering Cancer Center in New York City, neglected to mention multiple directorships and consultancy fees when completing conflict of interest disclosure forms for leading publications including the New England Journal of Medicine and the Lancet, the report found. Baselga also left out his industry payments when writing for Cancer Discovery, the journal of the American Association for Cancer Research (AACR), even though he was the joint editor-in-chief and president of the association."
Despite improved transparency, conflicts of interest remain issue in medicine
“These conflicts undermine the reliability and credibility of the guidelines,” Nissen told Cardiology Today. “I don’t think that disclosure is the antidote here. The antidote is for physicians who are involved in public policy discussions not to accept money for promoting drugs.”
Undisclosed payments in research
Payments, Conflict of Interest, and Trustworthy Otolaryngology Clinical Practice Guidelines
"Clinical practice guidelines (CPGs) are the cornerstone of the evidence-based practice of otolaryngology–head and neck surgery. The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) CPGs are widely distributed, as judged by frequency of downloads, webpage views, and CPG-related sessions at national meetings. Clinical practice guidelines are developed to reduce variation in care and to improve quality. They create debate and even controversy, with concerns expressed about restraints on clinician decision making as well as the medicolegal implications of recommendations. Clinical practice guidelines must be trustworthy, and the Institute of Medicine (IOM) and the Guideline International Network have provided standards for CPGs.1 A major threat to the creation of trustworthy guidelines is conflict of interest (COI) among the organizations and the committee members who create CPGs.
Forty-three percent of pediatricians receive industry payments
"The academic institutions of this country are allowing themselves to be the paid agents of the pharmaceutical industry. I think it's disgraceful."
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.
EpiPen maker failed to investigate product flaws associated with patient deaths, FDA says
"The FDA said Meridian Medical Technologies, a Pfizer company that manufactures the auto-injectors used to treat life-threatening allergic reactions, had detected faults in some units of the EpiPen and failed to adequately respond. In addition, the company received "hundreds of complaints" that the drug did not function properly -- "including some situations in which patients subsequently died."
Tom Frieden, Former CDC Director, Arrested And Charged With Sexual Abuse, Harassment
Medical Costs and Insurance
How drug companies make you buy more medicine than you need
This video talks about how pharmaceutical drugs are packaged and sold in ways that deliberately lead to waste, which creates costs that are then borne by the consumer. For some drugs such as chemotherapy drugs these costs can be very high. This issue is not something that the FDA regulates.
My Night as an ER Patient: How My Headache May Have Prevented A Stranger's Bone Marrow Transplant
Koch-backed study finds ‘Medicare for All’ would save U.S. trillions
It finally happened: Goldman Sachs asks 'Is curing patients a sustainable business model?
Frequency and Magnitude of Co-payments Exceeding Prescription Drug Costs
"A co-payment suggests sharing the total cost between patients and payers. However, drug co-payments sometimes exceed costs, with the insurer or pharmacy benefit manager (PBM) keeping the difference. Furthermore, some pharmacists are contractually prevented from alerting patients when their co-payment exceeds the drug’s cash price. Although some have argued that the practice is uncommon, a 2016 survey of independent pharmacists indicates otherwise."
Lawmakers grill Mylan CEO over EpiPen price hikes
"Jason Chaffetz (R-Utah), chairman of the House Committee on Oversight and Government Reform, held up an EpiPen to punctuate his point that epinephrine — “the juice” inside Mylan’s device — costs about $1 a dose. The list price of a two-pack of the pens is $608, up about 500 percent in a decade."
"You virtually have a monopoly, and you've used it to your advantage - but unfortunately, it's at the expense of people who need it," said Rep. Gerald E. Connolly (D-Va.). "I'm wondering what your sense of social responsibility is to those people."
High Insulin Prices Drive Diabetics to Take Extreme Measures
Diabetics Are Hacking Their Own Insulin Pumps
CNN Exclusive: California launches investigation following stunning admission by Aetna medical director
Why the U.S. pays more for health care than the rest of the world (Piece by NPR)
The case of the $629 Band-Aid — and what it reveals about American health care
We have all experienced the bizarrely high prices charged for many medical services and devices, and I think we can all relate to the parent who wrote this article about the absurdity of medical pricing.
Our daughter was born with half-a-heart. Instead of treatment, Cigna has put our family through insurance nightmare.
A Giant Pain in the Wallet
How an effort by the FDA to evaluate drugs that have been on the market since before testing was required has allowed pharmaceutical companies to price-gauge patients.
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."
The Reason Health Care Is So Expensive: Insurance Companies
"But the thing that few people talk about, and that no serious policy proposal attempts to fix—the arrangement that accounts for much of the difference between health spending in the U.S. and other places—is the enormous administrative overhead costs that come from lodging health-care reimbursement in the hands of insurance companies that have no incentive to perform their role efficiently as payment intermediaries."
"Because insurers are paid a fixed percentage of the claims they administer, they have no incentive to hold down costs. Worse than that, they have no incentives to do their jobs with even a modicum of competence."
Medical Bills Leading Cause of Bankruptcy, Harvard Study Finds
"Illness and medical bills caused half of the 1,458,000 personal bankruptcies in 2001, according to a study published by the journal Health Affairs. The study estimates that medical bankruptcies affect about 2 million Americans annually -- counting debtors and their dependents, including about 700,000 children. Surprisingly, most of those bankrupted by illness had health insurance. More than three-quarters were insured at the start of the bankrupting illness. However, 38 percent had lost coverage at least temporarily by the time they filed for bankruptcy."
Are Things Changing?
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