MedWorm.com provides a medical RSS filtering service. Over 5000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'The Antidote: Counterspin for Health Care and Health News' source. Sat, 16 Aug 2008 14:47:50 +0100 http://health-counterspin.blogspot.com/2008/07/straight-shooting-on-evidence-from.html Just noticed a new series exposing health care interventions that don't work, in the NYtimes... not in the health section, but in the business section. The first article is on an apparently dangerous prosthetic hip socket, and highlights the US' failure to implement device registries that could allow the identification of faulty implants of various kinds. Here's the blurb: The Evidence Gap: An Imperfect PictureArticles in this series will explore medical treatments used despite scant proof they work and will consider steps toward medicine based on evidence.I don't know how many of these are planned, but I imagine they could fill a couple years' worth of weekly columns. Regarding this article, I'd quibble with the idea that registry data are evidence, per se; the problem with interpreting the data is that there are no controls. One application for registry data stems from the fact that pre-market randomized trial data that provide actual evidence for devices (and drugs for that matter) are inadequate. In this case, the faulty devices in question were found to be contaminated with oil, more of a manufacturing quality-control issue than a general validity issue. The former point still holds, but registries can still provide a useful function in pointing to problems. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=1660651 Tue, 29 Jul 2008 02:55:00 +0100 1660651 http://health-counterspin.blogspot.com/2008/05/best-study-name-ever.html Thanks to my friend Pam Marcus for passing this along. I thought it was an appropriate way for me to celebrate my reentry into blogging.Lacasse A, Rey E, Ferreira E, Morin C, Bérard A: Validity of a modified Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scoring index to assess severity of nausea and vomiting of pregnancy. Am J Obstet Gynecol. 2008 Jan;198(1):71.e1-7. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=1416173 Fri, 02 May 2008 14:29:00 +0100 1416173 http://health-counterspin.blogspot.com/2007/11/thank-you-cbo.html California HealthLine today reports on a new Congressional Budget Office Report that finds that inefficient delivery of health care, and delivery of interventions of dubious value, will swamp the effect of the aging of the population in increasing health care costs over the foreseeable future. "The nature of the long-term fiscal problem has been misdiagnosed," Orszag said, adding that the aging population "is not by any means the main factor" behind the projected rise in cost growth. He noted that many new medical treatments and tests are "of dubious value." He said that in their efforts to stem the growth of health care costs, Congress and federal policymakers need to promote cost effectiveness and "evidence-based" medicine (Reuters, 11/13). Obviously Congress needs to take the lead in addressing this struggle. Senate Finance Committee chair Max Baucus pledged to address the problem aggressively; I hope he does, and I hope Budget Chief Orszag doesn't lose his job saying what needed to be said. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=1027040 Wed, 14 Nov 2007 18:59:00 +0100 1027040 http://health-counterspin.blogspot.com/2007/11/ny-times-nails-natural-claims-of-beauty.html Natural does not equal healthier, nor does it even equal, well, natural. An article in today's Times skewers the marketing ploys of a variety of beauty products available at stores like Whole Foods, and reiterates that there's no evidence that individual ingredients benefit health or beauty, or that claims of their natural or organic provenance are even necessarily true. Manufacturers profit handsomely on consumers' emotional beliefs that natural is somehow better. "We’re seeing an increased consciousness that what you put on your body is as important as what goes in your body,” said Jeremiah McElwee, the senior coordinator in charge of personal care at Whole Foods, which is the company’s fastest-growing department. “The biggest impetus for buying natural or organic body care is the perceived health benefit.” Emphasis on "perceived." (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=996475 Thu, 01 Nov 2007 12:30:00 +0100 996475 http://health-counterspin.blogspot.com/2007/10/new-website-on-reporting-guidelines.html The Equator website serves as a resource for consistent, accurate reporting in the literature of new research in a variety of health disciplines (e.g., systematic reviews, clinical trials, observational studies). Several of these disciplines have their own guidelines (e.g., the CONSORT guidelines for clinical trials), which are enforced by some of the leading journals. The site provides resources for authors, editors, and guideline developers.reporting guidelines (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=980470 Fri, 26 Oct 2007 03:23:00 +0100 980470 http://health-counterspin.blogspot.com/2007/10/another-online-evidence-based-medicine.html This one is from the University of North Carolina Health Sciences Library (my favorite library in the whole world, as it happens...) and the Duke University Medical Center Library.(The photo is of UNC's Old Well, which is more photogenic than the library...) (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=972653 Tue, 23 Oct 2007 23:32:00 +0100 972653 http://health-counterspin.blogspot.com/2007/10/new-qualitysafety-blog.html Robert Wachter, professor at UC San Francisco, author of Internal Bleeding, and patient-safety leader and innovator, has a new blog. This post nicely illustrates the health care quality learning curve as experienced by interns. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=972654 Tue, 23 Oct 2007 15:00:00 +0100 972654 http://health-counterspin.blogspot.com/2007/10/be-skeptical-be-very-skeptical.html The Kaiser Daily Health Policy Report has a piece today about an effort to survey Wellpoint's many (35 million) about their physicians in order to provide consumer-based rankings, also to include comments. All together now: "The plural of anecdote is not data." Indeed, as one consumer group interviewed by Kaiser said, these rankings are likely to be skewed to the negative by patients who have had bad experiences. There are better ways to collect consumer-centered data - for example, AHRQ's CAHPS measures - than mass rants of the type Wellpoint proposes. I don't have much use for Zagat's restaurant reviews, either, for the same reason. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=969993 Mon, 22 Oct 2007 16:17:00 +0100 969993 http://health-counterspin.blogspot.com/2007/10/gross-but-thought-provoking.html Kent Sepkowitz, writing for Slate, asks whether we might not be better off in terms of immunity by living under less sterile conditions. His recommendation to scientists: figure out if there's a level of excrement we can eat that would boost our immune systems without killing us. I imagine susceptibility varies by age, and I do know that we live longer as a population than we used to before sanitation. Other than that, I'm not a microbiologist, and I can't decide whether this idea is completely wacky or not. Any discussion? (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=941757 Wed, 10 Oct 2007 23:40:00 +0100 941757 http://health-counterspin.blogspot.com/2007/10/good-news-on-hospital-death-rates.html The Agency for Healthcare Research and Quality has released new data showing that mortality rates for six conditions and six procedures have declined steeply over a 10-year period from 1994 to 2004. In brief, AHRQ compared the death rates for 1994 and 2004 for patients who were hospitalized for heart attack, congestive heart failure, stroke, pneumonia, gastrointestinal hemorrhage, or hip fracture.For every 1,000 patients admitted for their condition: o Heart attack deaths fell by 43; deaths from congestive heart failure, pneumonia, and stroke each dropped roughly 30; deaths from gastrointestinal hemorrhage declined by 21; and 16 fewer died from hip fracture.For every 1,000 patients who underwent six surgical procedures examined: o Abdominal aortic aneurysm repair deaths plunged from 103 to 74; o Deaths from craniotomy – an operation for brain lesions and other conditions – declined from 83 to 68; o Deaths from heart bypass surgery fell from 48 to 28, angioplasty deaths diminished from 16 to 12, those from carotid endarterectomy – an operation to avert stroke – fell from 12 to 7, and o Deaths from hip replacement surgery declined by half – from 4 to 2 per every 1,000 operations.The death rates for the six conditions and six surgical procedures are risk-adjusted, meaning that AHRQ’s researchers took into account differences in how ill patients were over time when calculating the results. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=941758 Wed, 10 Oct 2007 21:15:00 +0100 941758 http://health-counterspin.blogspot.com/2007/10/isnt-getting-old-hard-enough-as-it-is.html The New York Times today reports on various forms of mistreatment and bias against elderly gay people, especially in assisted-living and long-term care facilities. There are not a lot of data here, just a few anecdotes and examples of efforts to address the problem, but that's ok - the fact that it ever occurs is unacceptable. And you can sort of see what's going on - elderly people slowly lose their ability to control the environment they live in, and the world at large is still quite homophobic. So if you've grown up in the closet and eventually gotten past all the barriers to coming out, you now find yourself in a position of going back in, or struggling mightily to surround yourself with people who will accept you.The problem simply had never occurred to me, and I have few words to express how sad it makes me. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=936707 Tue, 09 Oct 2007 12:00:00 +0100 936707 http://health-counterspin.blogspot.com/2007/10/why-universal-coverage-is-not.html Ezekiel J. Emanuel, bioethicist at the National Institutes of Health, lays it out in this Washington Post op-ed piece. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=933935 Mon, 08 Oct 2007 12:34:00 +0100 933935 http://health-counterspin.blogspot.com/2007/10/antidote-in-translation.html Scanning links to this blog in Technorati, I found that one of my recent posts (mostly consisting of data from AHRQ) has been fully translated into German! Thanks to Healthy Index for taking the time to include the content. Based on my very limited German, it does appear that this was done by a human, not by a machine like Babelfish, which is helpful in a pinch but not particularly reliable, and sometimes downright hilarious, at least for language geeks like me.Edit: thanks to my friend Z, with whom I probably should have checked before posting, for pointing out that it is an automatic translation after all. (Just goes to show how nonexistent my German really is these days...) So my new German readership are probably scratching their heads a bit.One of my readers pointed out the following amusing choice of a bullet, however:O arme Amerikaner really just means "Poor Americans," (meaning Americans without resources) not "Oh, you poor Americans." At least I think it does... Europeans don't feel that sorry for us, do they? (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=933140 Sun, 07 Oct 2007 12:57:00 +0100 933140 http://health-counterspin.blogspot.com/2007/10/ahrq-e-updates-available.html The Agency for Healthcare Research and Quality has a new email notification service, where users can sign up for new Agency information (research, guidelines, etc.) in categories of their choosing. Sign up here.health care quality (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=925202 Wed, 03 Oct 2007 21:02:00 +0100 925202 http://health-counterspin.blogspot.com/2007/10/more-on-health-coverage-case-study.html From the macro-level previous post, to the micro... Ryan Healy, at The Brazen Careerist blog, a 20-something writer, muses on the implications of taking a job without health insurance and buying individual coverage. (He also touches on issues of screening and prevention.) Whether or not Ryan intended to make a political statement with this piece, it's a good illustration of just why universal health care is a good idea. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=925203 Wed, 03 Oct 2007 14:15:00 +0100 925203 http://health-counterspin.blogspot.com/2007/10/update-on-health-insurance-coverage-in.html The Agency for Health Care Research and Quality (AHRQ) has just released data on the extent of lack of health coverage, and in particular the lack of continuity of coverage. This is of course a central issue for presidential candidates and others who are debating what to do about the problem. From AHRQ's News and Numbers:More than 17 million Americans under age 65 – almost a third of whom are middle income, could be considered continuously uninsured. This means that they have not had health insurance to help cover their medical bills for at least four years, according to the latest News and Numbers from the Agency for Healthcare Research and Quality. Middle income Americans are defined as living in families earning between 200 percent and 400 percent of the federal poverty thresholds, which vary according to family size and composition. In 2004, the base year for these data, poverty level income for a family of four averaged $19,307. From AHRQ's News and Numbers: The AHRQ data examined Americans who were continuously uninsured for at least four years between 2002 and 2005 as well as those who were uninsured for shorter periods over those years. The AHRQ data also show that: o Poor Americans, those in families with incomes at or below the Federal poverty line, comprised about a quarter of the continuously uninsured. In contrast, less than 10 percent of the continuously uninsured were people who lived in families with incomes over 400 percent of the Federal poverty line. o Fully 17 percent of Hispanics were continuously uninsured, compared with 7 percent of blacks, and 4 percent of whites. o Some 12 percent of people age 25 to 29 years of age were continuously uninsured, followed by Americans age 18 to 24 (11 percent), 30 to 34 (10 percent), 35 to 54 (8 percent), and 55 to 64 (5 percent). However, only 2 percent of children and adolescents under 18 years of age were continuously uninsured. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=925204 Wed, 03 Oct 2007 12:54:00 +0100 925204 http://health-counterspin.blogspot.com/2007/09/aviation-safety-revisited.html An article from today's New York Times describes a 65% drop in plane-crash fatalities over 10 years, accomplished in large part by identifying seemingly small problems that often precede crashes. Now that there are so few crashes, and data are sparse, the industry has reversed its learning patterns and analyzes flights that go well.Apparently aviation is learning from its mistakes. Can hospitals - where, in an era of tens of thousands of deaths due to errors per year, data are not sparse - do the same? (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=916054 Mon, 01 Oct 2007 01:53:00 +0100 916054 http://health-counterspin.blogspot.com/2007/09/polypharmacy-awareness.html The New York Times today had an article by Jane Brody describing the phenomenon of polypharmacy: simply put, too many drugs, whether prescription, over-the-counter, or both. It's a particular problem in elderly patients, who suffer from multiple conditions, and who often see multiple doctors who don't know what other drugs patients are taking. Those drugs often interact, producing additional morbidity and even death.Here are some sobering data describing the incidence of polypharmacy: Polypharmacy is responsible for up to 28 percent of hospital admissions and, he added, if it were classified as such, it would be the fifth leading cause of death in the United States.Polypharmacy can even occur when doctors do know what other doctors have prescribed, but are afraid to override other doctors' decisions. There's an increasingly useful role for consultant pharmacists, who, despite their superior training in identifying potential interactions, often come into conflict with physicians when they question prescriptions.I'm glad, however, that the term "polypharmacy" is now out there in the New York Times. Increased awareness of polypharmacy is one way in which patients and their families can be better advocates for their own care. Changing the culture of medicine and reducing the fragmentation of health care to reduce risk of polypharmacy are, again, as we all know, different stories entirely. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=909348 Fri, 28 Sep 2007 00:46:00 +0100 909348 http://health-counterspin.blogspot.com/2007/09/massachusetts-moves-toward-transparency.html The California Health Care Foundation's ihealthbeat online newsletter today reported that Massachusetts plans to post payment data on hospitals online, based on a recent Boston Globe article. Specifically, each hospital will be required to post average payments made by each insurer for certain procedures, the idea being to allow consumers to comparison-shop for hospitals on the basis of costs. Hospitals will also post quality information on these procedures, but the specific procedures have not yet been decided upon.New Hampshire has posted payment data, but not quality data, on a range of types of hospitalizations, some of which may be more feasible than others for comparison shopping. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=895767 Mon, 24 Sep 2007 18:45:00 +0100 895767 http://health-counterspin.blogspot.com/2007/09/best-sciencepolitics-article-of-week.html President Bush, something of an "armchair physicist," discovered an error in a particle-physics article from Fermilab, and modestly described the error to scientists at the lab and to the press.Thanks, Onion! (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=888490 Thu, 20 Sep 2007 14:38:00 +0100 888490 http://health-counterspin.blogspot.com/2007/09/senate-passes-mental-health-parity-bill.html New legislation passed today by the U.S. Senate will ensure that all health insurance plans cover mental health care at the same level as coverage for general health issues.This reform is long overdue. From my own perspective, I recently picked up temporary health coverage with a modest premium of about $230 per month, and noticed when I got the paperwork that it didn't include a mental health rider. When I inquired about the cost with the mental health coverage, I was told my monthly premium would be on the order of $800 per month. So I skipped it, and prayed for mental fortitude, though as far as I know, prayer is not an evidence-based preventive intervention against mental illness. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=885300 Wed, 19 Sep 2007 15:10:00 +0100 885300 http://health-counterspin.blogspot.com/2007/09/pearlstein-on-clintons-health-care.html Steve Pearlstein of the Washington Post writes today that Hillary Clinton's new plan, announced this week, is the best among those of the Democratic candidates. Of all, the candidates, in fact; Pearlstein says about the Republicans, The knee-jerk response from Republicans was to smear her proposal as "socialized medicine," a fresh reminder of how illiterate, out-of-touch and irrelevant the Republicans have become on the most important domestic issue to voters. Hey, he said it, I didn't.Pearlstein cautions that Clinton has a lot of political work and voter education to do to sell the crucial nuances and inevitable tradeoffs of her proposal. Where I would start is by stressing that rationing is not necessarily a bad word; it doesn't have to be about profits for the insurance industry (though under Clinton's plan that will likely be the reality, at least in part), and it could actually improve health care both for individuals (by limiting the use of unproven, potentially risky procedures) and certainly for the population as a whole (by allowing more equitable distribution of resources). I'd like to see more details on modernizing Medicare in this regard.But how can we get Americans with good health coverage to see that they may not need everything that they're currently consuming? (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=885301 Wed, 19 Sep 2007 14:45:00 +0100 885301 http://health-counterspin.blogspot.com/2007/09/free-online-evidence-based-health-care.html The U.S. Cochrane Center at Johns Hopkins University's Bloomberg School of Public Health is offering a free online course in evidence-based health care. It's designed for consumers and consumer advocates who need to be able to distinguish high-quality research evidence from evidence that's not so reliable. The U.S. Cochrane Center is part of the worldwide Collaboration, comprising some of the world's gurus on evidence based medicine, and the course is taught by breast-cancer survivor and patient advocate Musa Mayer, and was co-developed by Kay Dickersin, Cochrane Center director. A little quiz: I've attached the nifty logo of the Cochrane Collaboration. Would anyone care to describe what it represents? (Epidemiologists should hold back, at least for now.)evidence-based medicine (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=882519 Tue, 18 Sep 2007 23:02:00 +0100 882519 http://health-counterspin.blogspot.com/2007/09/getting-health-care-priorities-in-order.html Shannon Brownlee, whom I interviewed on this blog a few months ago, has an article in the new Washington Monthly on why we need to fully fund AHRQ (the Agency for Healthcare Research and Quality - remember it!), and all the reasons why it's important to insist on evidence in health care. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=861637 Tue, 11 Sep 2007 02:46:00 +0100 861637 http://health-counterspin.blogspot.com/2007/09/bee-science.html Researchers finally have a clue about the mass disappearance of pollinating honeybees from hives across the country and elsewhere, as reported in today's NYTimes: a virus, the presence of which was 62 times more likely in hives that had collapsed than in those that had not. Because the very strong association could still be a coincidence, however, To try to clarify cause and effect, the researchers said they were preparing a new suite of tests in which isolated bee colonies would be intentionally infected with the virus, both with and without possible secondary causes like certain parasites.I guess you could call it epiapiology (to mix Latin and Greek)... (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=849802 Fri, 07 Sep 2007 21:27:00 +0100 849802 http://health-counterspin.blogspot.com/2007/09/immigrants-and-mental-health.html Just read this chat on washingtonpost.com about access to mental health among immigrants to the U.S., with Dr. Hochang Benjamin Lee of Johns Hopkins. Here's a related article from earlier in the week, which suggests (without a lot of hard data) that immigrant parents are likely to be in denial about their children's mental illness, among other barriers. Both of these are apropos of this week's state of Virginia report on the mental health of Seung Hui Cho, the Virginia Tech student who killed 32 people and then himself. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=849803 Fri, 07 Sep 2007 16:28:00 +0100 849803 http://health-counterspin.blogspot.com/2007/08/how-americans-get-information-on-health.html New results from a federally funded survey are out that describe trends in sources Americans use for finding health information. The survey revealed that we trusted our health care practitioners more in 2005 than in 2003, but the internet somewhat less between those two years. That, of course, is before this blog was born (August, 2006), so the internet trend may yet reverse ;-) . (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=832490 Thu, 30 Aug 2007 13:50:00 +0100 832490 http://health-counterspin.blogspot.com/2007/08/republican-health-care-positions.html For the record, and posted without comment, here's a link to a Kaiser Family Foundation summary of a presentation on health care by Republican presidential candidates, sponsored by the Lance Armstrong Foundation. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=829901 Wed, 29 Aug 2007 17:15:00 +0100 829901 http://health-counterspin.blogspot.com/2007/08/tough-talk-on-improving-health-care-in.html Today's NYTimes has a story about Robert Sillen, the court-appointed federal receiver chosen to overhaul health services in California prisons as the result of a class-action lawsuit. Sillen does not mince words with legislators in Sacramento and has no patience, for example, for political rhetoric about keeping felons off the street that elected officials must adopt. He also dismisses the idea of setting goals and monitoring progress in health care improvement. The Prison Law Office filed a complaint in federal court in June saying that Mr. Sillen’s plans have “no concrete details of how any of the goals or objectives are to be accomplished, no real timelines and no metrics.”In an interview in his office in San Jose, Mr. Sillen dismissed the group’s assertions. “When people ask me how long and how much,” he said, “I have a stock answer: Long. Much.” This, of course, is a mistake. I'll give him the benefit of the doubt and say he's just being contrary for the benefit of the media, but I'd be happy to help him with such a project.The Receivership website is here. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=824559 Mon, 27 Aug 2007 20:23:00 +0100 824559 http://health-counterspin.blogspot.com/2007/08/more-on-lack-of-regulation-of-lead-in.html Much more, from Slate.com.The plot thickens. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=816571 Wed, 22 Aug 2007 18:21:00 +0100 816571 http://health-counterspin.blogspot.com/2007/08/catching-up-on-health-blogosphere.html Maybe all of you keep up better than I do with the health care sector of the blogosphere and this is a useless exercise, but here's the thing: sometime during my 6-week hiatus from blogging, my feed reader went dead, and I had stopped looking at it anyway. Today, though, I fixed it, and found a bunch of good stuff that seemed worth sharing. Here are some highlights (most of them, in fact, current).At the Health Affairs Blog, a UK doctor writes about the ups and downs of pay-for-performance in the National Health System.I didn't know, but I had wondered, what role the U.S. government might be playing in keeping China manufacturer-friendly; the Pump Handle blog today points to a McClatchy newspaper article alleging that the Bush administration has fought inspection rules that might have prevented recent lead poisonings from toys made in China. I found the article itself a little skimpy on facts, but I imagine - hope? - it's just the beginning of investigation on this issue.This sounds like something I should be writing more about: the idea that a virus causes obesity, and the viral spread of the idea in the news. Read Knight Science Journalism Tracker's take on news coverage here. Here's an obesity story I liked better, from Nature Newsblog, about how chimps practice dietary self-control; it's good to remember that, in the end, we are all apes. (Yes, even you, unless you happen to be that rare gerbil or komodo dragon who reads blogs.)Thanks also to the KSJ Tracker for this cool science story (not about health, but I couldn't resist) about a juvenile sooty shearwater - a wide-ranging seabird, photo above - in New Zealand that had picked up a tiny tracking device implanted in a salmon in the Pacific Northwest of the U.S.White Coat Notes, from the Boston Globe, reports that Harvard researcher and patient safety guru Lucian Leape approves of the new Medicare non-reimbursement rules, because, in Leape's words, We’ve got a lot of solutions out there and the thing that is so frustrating is they haven’t been implemented.Finally, Gary Schwitzer wrote about the increasing infomercialization of health segments on local TV news station. Scary. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=815087 Wed, 22 Aug 2007 01:47:00 +0100 815087 http://health-counterspin.blogspot.com/2007/08/just-trying-to-figure-out.html why this blog has a whole raft of hits today emanating from my interview with Nick Genes last December, when I hosted Grand Rounds.So if you're coming from there, did someone else recently link to that interview?Not paranoid, just wondering. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=814088 Tue, 21 Aug 2007 23:32:00 +0100 814088 http://health-counterspin.blogspot.com/2007/08/national-quality-forum-request-for.html Just passing along a request for comments...August 20, 2007 UpdatePublic Comments Requested for Three NQF Reports. NQF is pleased to announce that the following three draft reports are available for public comment. Comments must be received by Friday, September 7, 2007, 6:00 pm, EDT. NQF is now using a program that facilitates electronic submission of comments. * National Voluntary Consensus Standards for Ambulatory Care: Cycle 3 * National Voluntary Consensus Standards for Ambulatory Care: Measuring Healthcare Disparities * National Voluntary Consensus Standards for End Stage Renal Disease CareQuestions about the NQF and/or this email can be directed to info@qualityforum.org or 202.783.1300. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=811000 Mon, 20 Aug 2007 22:21:00 +0100 811000 http://health-counterspin.blogspot.com/2007/08/preventing-motor-vehicle-injuries-in.html The US Preventive Services Task Force has just issued its findings on counseling for seat belt use and on drinking and driving in the primary care setting. The Task Force basically identified critical research gaps for both: they concluded that there is insufficient evidence to assess whether physicians' counseling of patients on seat belt use or drunk driving adds to existing public health efforts such as legislation.Such evidence gaps are, unfortunately, common amongst evidence-based primary care recommendations.Anyone at NIH or CDC want to fund a study? (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=811001 Mon, 20 Aug 2007 21:27:00 +0100 811001 http://health-counterspin.blogspot.com/2007/08/more-on-bloggers-weigh-in-on-medicare.html The Physician Executive blog and Medpundit ("You Broke It, You Bought It") have posted their thoughts on the new Medicare rules stipulating that treatment of certain preventable adverse events and health care-associated infections will not be reimbursed. It's worth reading the comments on each, also those at Paul Levy's blog. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=811002 Mon, 20 Aug 2007 21:13:00 +0100 811002 http://health-counterspin.blogspot.com/2007/08/mike-leavitt-starts-blog.html US Department of Health and Human Services Secretary Mike Leavitt has a blog. Sounds like he's writing it himself, but will have help managing the comments, and therein lies, I imagine, the challenge. Cheerfully posting HHS news updates is one thing, confronting the masses head-on and transparently in this format will be quite another. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=808577 Sun, 19 Aug 2007 21:13:00 +0100 808577 http://health-counterspin.blogspot.com/2007/08/preventing-medical-errors-official.html Medicare now says that it won't reimburse hospitals for hospital-associated infections, or the sequelae of serious adverse events, according to an article in today's New York Times. About 100,000 deaths per year are estimated to occur from hospital-acquired infections alone, and treating such infections is estimated to cost billions of dollars. The idea behind the new rules is that such events are preventable, and that non-reimbursement will further compel hospitals to take steps to ensure that they don't occur. Hospital organization representatives interviewed in the article question the extent to which adverse events and infections are, in fact, preventable. (Paul Levy, CEO of Beth Israel Deaconess Hospital and blogger, believes that infections are preventable, and has written at length - e.g., here - about his hospital's goal of zero infections.) Hospitals also worry that they'll be have to spend more of their own money on tests of infection upon admission so that they can demonstrate that certain infections are community-acquired. It'd be an interesting economic analysis (that I'm not qualified to make) to see whether diligently working toward zero infections, in a climate of nonreimbursement for infections, pays off as well as investing dollars to try and prove that infections are not hospital-acquired, though the latter could provide interesting data if studied rigorously.More details on this initiative soon. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=808578 Sun, 19 Aug 2007 14:28:00 +0100 808578 http://health-counterspin.blogspot.com/2007/08/more-on-aging-in-for-better-or-for.html Today's For Better or For Worse comic strip (go to August 16, 2007, in the archive if it's not visible when you look) addresses the issue of polypharmacy: the grandfather, who is working to recover from aphasia caused by a stroke, is apparently depressed, and when his daughter suggests upping his meds, his wife replies that he's already taking too many.Tough one. It'll be interesting to see how the strip, which takes place in Canada, resolves this issue. Will they bring in a consulting pharmacist to review all Grandpa's meds? Will they find a way, given that he can't talk, to engage him in psychotherapy (e.g., instant messaging)? Or will he be miraculously and glibly cured - maybe even of the aphasia - from an insight experienced, say, in the presence of one of his grandkids or great grandkids?In any case, the thread is a refreshing break from the saccharine and highly annoying romance of Anthony and Lizard Breath (see, for example, August 11 in the archive). (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=802172 Thu, 16 Aug 2007 10:34:00 +0100 802172 http://health-counterspin.blogspot.com/2007/08/grand-rounds.html Please check out medical blogging's Grand Rounds hosted this week at Med Journal Watch. It's been much too long since I submitted anything to Grand Rounds; I really need to get with the program. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=799161 Tue, 14 Aug 2007 22:58:00 +0100 799161 http://health-counterspin.blogspot.com/2007/08/kids-brainwashed-by-advertising.html This article in today's NYTimes describes how kids prefer foods that come in McDonald's packaging to the same foods in plain wrappings. Apparently the official McDonald's response is to add healthier foods - with the proper appealing packaging - to their lineup, rather than cop to the brainwashing.As summed up by one of the researchers, “We often hear that parents are the ones responsible for their kids’ nutrition,” Dr. Robinson said, “but in reality there are these other factors, created by a tremendous amount of advertising effort, that undermine parents’ ability to make healthy choices.” (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=797873 Tue, 14 Aug 2007 12:15:00 +0100 797873 http://health-counterspin.blogspot.com/2007/08/evidence-is-main-issue-for-supplements.html Interesting perspective on prioritization of research on dietary supplements, from Mark Moyad, Director of Preventive and Alternative Medicine at the University of Michigan. Thanks to The C.A.M. Report blog for pointing this out. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=790505 Thu, 09 Aug 2007 23:59:00 +0100 790505 http://health-counterspin.blogspot.com/2007/08/raw-milk-russian-roulette-is-right.html My usual morning newspaper routine includes reading the health sections on Tuesdays, and the food sections on Wednesdays. I gather the raw milk people have been plastering news outlets with press releases recently, because Sally Squires' Lean Plate Club column yesterday in the Washington Post health section was pretty direct about the risks of drinking raw milk, and the Times reported on it in today's Food section (see below). Squires' column reports a number of recent cases of milk-borne bacterial illness in humans (there are a number of pathogenic bacteria specific to milk), and gives good data on the extent of the problem: raw milk from a quarter of the farms tested had disease-causing bacteria in it. Particularly telling regarding public understanding is Squires' online chat yesterday, where a number of people wrote in to say, basically, that they drank raw milk all the time growing up and never got sick. As I always say, though, the plural of anecdote is not data. People, did you read Squires' column? Today, the New York Times reports in the food section on raw milk, and the struggle over whether it should be legal or not. Writer Joe Drape interviews a number of raw milk fineshmeckers, some of whom even feed it to their kids, who have apparently fallen for the improved healthfulness arguments cited in Squires' article. More enzymes? Sorry, they're destroyed as soon as they hit the stomach. Maybe it tastes better but, as the Center for Science in the Public Interest points out in the Times article, universal pasteurization led (early in the 20th century) to a precipitous drop in the proportion of food-borne illness caused by milk. Otherwise, the Times does not offer any data on risks, just perceptions. I think many people are more likely to fall back on their own experience than to pay attention to hard numbers. Some consumers, those who are more likely to prefer small, organic farmers over large industrial farms, for example, (and I sympathize, but for other reasons) may prefer to take their chances with "natural." They might believe the hokum spouted by the Sally Fallon, who is trying to promote consumption of the who says that non-industrial dairy-produced milk has its own antimicrobial properties. Is that so? Well, until you submit your magic milk for bacterial testing along with everyone else, I'm not touching it. In this case, I'll side with the National Dairy Council official quoted by Squires, who said that that drinking raw milk is "like playing Russian roulette" - it's hard to argue with that. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=786644 Wed, 08 Aug 2007 11:32:00 +0100 786644 http://health-counterspin.blogspot.com/2007/08/update-from-health-news-review.html Gary Schwitzer, who runs a site called Health News Review that systematically reviews the quality of health news, has posted highlights from the site over at the World Health Care Blog. Gary points out a number of disappointing stories in recent national health news. I, for one, am grateful that Gary has continued to mind so ably the quality-of-health-news store while I've been off investigating new directions (nothing terribly exciting to report as a result, I'm afraid) and noticing what it's like not to blog regularly (was harder to stay away than I expected). (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=785831 Wed, 08 Aug 2007 00:18:00 +0100 785831 http://health-counterspin.blogspot.com/2007/08/where-are-standards.html I was surprised this morning to find that the Washington Post had published this piece. It's about a biochemist who is promoting manuka honey from New Zealand as a wound-healing agent, and it also does a pretty good job of promoting manuka itself.But the article presents almost no evidence that manuka works. Instead, it interviews other honey experts, who lament the slowness of the medical community in accepting alternative treatments. The writer does, to his credit, quote researchers in the field who acknowledge that more research is necessary - including in vivo studies. One small, unpublished study is described: it's not clear whether it was s randomized, and though 7 of 10 wounds colonized with MRSA were no longer colonized at the end of the study, no comparison result is offered. Apparently the FDA has approved manuka as a wound dressing, but what does that mean? that they don't think it will kill you? and if so, how do they even know that? Are the standards different for wound dressings from, say, anti-cholesterol drugs?Why so much fuss about something that hasn't even reached the level of credible research? The article has that alternative-medicine air of "let's take back medicine from evil Pharma, and go back to natural remedies used for thousands of years" - even if there's really no good evidence that those natural remedies were actually effective or safe. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=785832 Tue, 07 Aug 2007 14:13:00 +0100 785832 http://health-counterspin.blogspot.com/2007/06/hospital-compare-adds-patient-outcomes.html The Centers for Medicare and Medicaid Services (CMS) has just added 30-day mortality measures for heart attack and heart failure patients (separately). These are the first actual patient outcome measures to be included in this national, voluntary, hospital-specific public reporting database. In addition to the rates themselves, the site compares the rates to the national average (better, about the same, or worse). The rates are also risk-adjusted to even out differences in the underlying morbidity of patients. The 30 days include patients who die outside the hospital, because there are also differences in how quickly hospitals discharge patients. This is, however, a potential source of error, because it's fairly difficult to capture deaths that occur outside the hospital. Last time I checked, there was a substantial time lag before such information was available via national data sources. If readers know how hospitals typically get such information, I'd be interested. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=689923 Fri, 22 Jun 2007 14:11:00 +0100 689923 http://health-counterspin.blogspot.com/2007/06/top-100-health-care-blogs.html (Warning: potentially confusing cross-referencing ahead...) Thanks to Tony Chen of Hospital Impact, and one of my fellow World Health Care Bloggers, for pointing out the Healthcare 100 blogs, indexed by rankings in Google, Bloglines, Technorati, and eDrugsearch. The World Health Care Blog is number 47, and The Antidote is number 58! Lots of other blogging colleagues/buddies of mine are there as well; check it out. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=674328 Fri, 15 Jun 2007 14:16:00 +0100 674328 http://health-counterspin.blogspot.com/2007/06/chemotherapy-profits-vs-questionable.html A story in the NYTimes today reports that oncologists are still trying to find ways to profit from treating their patients with expensive drugs, even though Medicare has cracked down on such profits two years ago (by limiting the markups docs can charge to 6% above the cost of the drug). Doctors can get around the limitations in reimbursement by simply offering drugs to more patients, whether or not they'll benefit from them.“There’s pretty good evidence at this point,” said Dr. Richard Deyo, professor of medicine at the University of Washington and an expert on health care spending, “that there are plenty of patients for whom there’s little hope, who are terminally ill, whom chemotherapy is not going to help, who get chemotherapy.” Some doctors claim that the Medicare limitations are going to result in a lack of access to needed drugs for patients in rural areas, for example, although an unspecified federal commission cited by the article found this not to be the case.In such a climate, how common are honest conversations between doctors and patients about the risks and benefits (not to mention the costs) of chemotherapy in terminally ill patients? I'd like to see studies on utilization of chemotherapy in settings where oncologists can't profit from use of the drugs (and I'm not sure where those are, given multiple payers, including Medicare, available in most care settings in the US), compared to those where they can. The extra-credit part would be comparing real health outcomes - not 5-year survival! - in different settings. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=674330 Tue, 12 Jun 2007 14:06:00 +0100 674330 http://health-counterspin.blogspot.com/2007/06/fog-of-medicine.html Baffling news from the recent American Society for Clinical Oncology meeting, about which the public should probably not yet make too much of a fuss; however, the NY Times chose to report on it, so there you are. Here's my take on what I've read in today's article.Researchers presented an analysis of pathology samples from a study that had previously shown that breast cancer patients classified as positive for the HER-2 gene allowed them to benefit from treatment with trastuzumab (Herceptin). Another look at the HER-2 positive samples showed that 20% of them were actually HER-2 negative - and yet half of those women benefited from treatment with trastuzumab, a drug that specifically targets HER-2.This could mean any (or more than one) of three things, none of which we have enough information at this point to be confident:- the tests (immunohistochemistry - for the protein - and fluorescence in situ hybridization - for the gene) are worse than we thought- the threshold for classifying a patient as HER-2 positive is wrong- trastuzumab is not as specific to HER-2 as we thought (suggesting that women with HER-2 negative tumors could also benefit)The studies described are small, and even those at the meeting (including the Times writer) did not have the benefit of all the methodological and data details we would in a peer-reviewed, published paper. In other words, these findings are meant to be chatter amongst investigators, and to suggest directions for more definitive research: for example, why did the women in the early studies test positive for HER-2, and negative now? were there other genes involved that could affect the results of the tests and/or the activity of trastuzumab? I'm not a molecular biologist, or an oncologist, so I'll stop there. Regarding the NYTimes story itself, if it had fallen clearly into the excitement-of-science category, perhaps - perhaps - I'd have been OK with it, but there's a little too much hype offered up front by a National Cancer Institute scientist, suggesting that the results are potentially "practice-changing." (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=674329 Tue, 12 Jun 2007 13:14:00 +0100 674329 http://health-counterspin.blogspot.com/2007/06/democratic-candidates-debate-excerpts.html The Kaiser Family Foundation has posted a compilation of health care-related excerpts from the recent Democratic candidate debate in New Hampshire. (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=674331 Wed, 06 Jun 2007 17:09:00 +0100 674331 http://health-counterspin.blogspot.com/2007/06/early-detection-of-cancer.html My fellow blogger Orac, an oncologist, has a great post (from back in April; somehow I missed it) on why screening for cancer is a complicated issue that should be approached with cautious weighing of risks and benefits. And here's his Part 2, with specific reference to breast cancer.Be sure to read the comments - surprisingly, all were supportive - and check out the 9-minute video offered in the first post by Tracy of Dr. Barry Kramer (full disclosure: he's my former boss). (Source: The Antidote: Counterspin for Health Care and Health News) The Antidote: Counterspin for Health Care and Health News blogs http://www.medworm.com/rss/comments.php?id=658560 Mon, 04 Jun 2007 19:28:00 +0100 658560