Archive: February, 2011
Michael Cohen
Parents are often given open visiting hours to be with their hospitalized child. Many parents take advantage of this option and remain with their child as much as possible. For an ill child, this can be comforting and provide an important emotional benefit, which at times might help them get better faster. In fact, a study by Swiss researcher Bernhard Frey and colleagues, suggests that parents who stay with their hospitalized child can help detect potential adverse events, such as medication errors.
In one case, a mother realized her child had been prescribed the wrong dose of a heart failure medicine. The error would have given her child five times more medicine than needed. In another case, a mother noticed that the wrong weight was listed on her child’s medical records. Since the weight was used to calculate doses of medicine, it could have led to an overdose had she not caught it. All of these events were detected by parents only after visiting hours were no longer restricted to just a few hours a day. This suggests that it is easier for parents to detect safety problems if they spend more hours at their child’s bedside, observing and participating in their care.
However, the same study also showed that parents can sometimes cause the harmful event. The most common problems to which parents contributed involved the misconnection of tubes and drains, errors with medicines, and physical trauma. One mother who was breast feeding her baby accidentally disconnected intravenous tubing. Another mother accidentally disconnected a chest tube while holding the child. In another case, a father fells while his child was on his lap. Most of the disconnected tubes and drains happened in very young children.
These errors by parents were discovered by hospital staff within an average of 15 minutes. Most of these events caused moderate harm. However, quick discovery of the problems averted serious harm.
Don Sapatkin
Opponents of President Obama’s health-care overhaul have focused on the requirement that most people buy insurance by 2014 or face penalties if they don’t. They say Americans deserve freedom of choice, not government mandates.
Fair enough, says State Rep. Mark Longietti, a Democrat from Western Pennsylvania. But be consistent: Lift the mandate on hospital emergency rooms to screen and treat everyone who comes through the door in dire straits.
If someone who risked not buying insurance arrives on a stretcher, he asks, “should the response be: ‘I’m sorry, you decided to take the risk … you are going die’?”
Longietti’s mandate analogy came during a House Democratic Policy Committee hearing on health care Wednesday in Philadelphia. He wasn’t seriously suggesting that uninsured patients be left to die in the ER.
Robert Field
Imagine Donna Dubinsky’s surprise when she was turned down for health insurance. The reason? She had a corn on her toe.
Donna had applied for individual coverage for herself and her family, after they lost benefits through her husband’s employment. (This is coverage sold directly to the public with no employer involved.) No family member had ever had a serious medical problem, but all were rejected for minor ailments. She chronicled the ordeal in a recent Op-Ed in the New York Times .
Kathy and Henry Hamman suffered a similar fate when they applied for individual policies at the age of 61. Neither had a history of serious conditions, but BlueCross BlueShield of Tennessee took only a few days to turn them down.
Donna, Kathy and Henry are hardly alone. Over 12 million Americans were reportedly rejected for individual policies over a recent three-year period. That’s over one-third of all who applied. For those between 55 and 64, the rate is closer to 40 percent.
Don Sapatkin
Exploring Chinatown after moving to Thomas Jefferson University Hospital last summer, emergency-room doctor Gerald F. O'Malley noticed brightly colored ceramic cookware for sale everywhere. It triggered decade-old memories of treating Mexican children in Denver whose lead poisoning he had suspected - but never got a chance to test - was due to pottery from home.
Could that be happening here?
O'Malley quickly assembled a team of medical students to purchase and screen several dozen glazed plates, cups, spoons, and teapots. The initial results: 25 percent of the items from Chinatown shops contained lead, as did 10 percent of Chinese-made products bought elsewhere.
Public-health officials say there is no evidence that the decorated tableware has caused elevated lead levels in children, which are carefully tracked. But much about lead remains unknown. And the minimum level believed capable of harming a developing brain has been lowered repeatedly.
Daniel Hoffman
Right-wing ideologues and corporate sycophants are attacking plans by the White House to shorten the patent exclusivity of biological drugs from twelve years to seven.
The National Review views this reduction of patent protection as the ultimate criticism of pharma's 2009 deal to support President Obama's health care legislation. The Wall Street Journal frames the patent adjustment from the perspective of branded drug companies, referring to the change as something that will stifle the development of breakthrough drugs. This wailing prompts four, top-of-mind responses.
(1) The Republicans have made budget cutting their number one goal. President Obama is obliging them and legitimating their crackpot reasoning, but the Republicans just don't like it when their ox is gored. Pharma has long been a major financial backer of Republicans and the 2009 deal on healthcare legislation notwithstanding, such loyalties run deep. In the mid-term elections last year, that classic alignment was reconfirmed when Republicans again received the overwhelming share of pharma contributions.
Now as any good finance manager will tell it, when a budget maker looks to make reductions, he cuts wherever he can. According to a study just completed by IMS, one of the world's largest suppliers of market data on the health care industries, the US saved nearly $1 trillion between 2000 and 2009 by using generics instead of premium priced brands. Republicans want to cut expenses and the White House is merely suggesting that reducing the government-granted monopoly by five years on products that already returned huge profits to their developers is a reasonable way to do it.
Michael Cohen
Patients taking the new anticlotting drug Pradaxa may be in for a surprise. The capsules deteriorate quickly when exposed to humidity, and come with just a 30-day expiration date. Even some pharmacists appear not to be aware of this, and we are already hearing of patients having to throw away this expensive new medication.
Pradaxa (dabigatran) is designed to help prevent stroke in people with atrial fibrillation, causing the heart’s upper pumping chambers to beat in helter-skelter fashion. According to FDA, more than 2 million patients have atrial fibrillation. This puts these patients at risk of developing blood clots that could travel to the brain and cut off oxygen.
Until now, most patients have been treated with the anticlotting drug (“blood thinner”) warfarin (Coumadin). With warfarin, it’s important to monitor patients with a blood test to assure not only effectiveness but also that the blood isn’t too “thin,” which could lead to bleeding.
Unlike warfarin, Pradaxa capsules are given in a fixed dose of 75 mg or 150 mg, morning and evening. There is no need to monitor blood tests to guide proper dosing and there aren’t any important interactions with food and only minimal drug interactions. This is not to say the drug is without any risk. There is still a potential side effect of life-threatening bleeding and other problems such as stomach discomfort and bloating.
Robert Field
No one wants the government to ration health care. Least of all, many of health reform’s staunchest opponents. They warned that Obamacare is a veiled attempt to let bureaucrats decide what treatments our doctors can give us.
As it turns out, we didn’t have to wait for Obamacare to take effect to see government rationing in action. States across the country have started using it to control spending, and there is more to come.
The rationing is taking place in state Medicaid and similar programs that provide benefits to the poor. The most dramatic initiative took effect last fall, when Arizona’s Medicaid program stopped paying for many kinds of organ transplants. The state claimed they are not worth the cost.
At the time, there were indications that the legislature would reverse the action. But when it reconvened in January, it failed to act. To the contrary, Republican Governor Jan Brewer is now looking to cut Medicaid even further.
Michael Cohen
By Michael R. Cohen: president of the Institute for Safe Medication Practices
A young mother went to her local pharmacy the other day to find medications for her small children, who were suffering from bad colds. In the cough and cold section, she saw a bottle of Triaminic liquid and decided to buy it, remembering Triaminic as a cold medicine. She also picked up a bottle of store brand acetaminophen, the main ingredient in Tylenol, for their fever and sore throats.
Without knowing it, she actually had two bottles of acetaminophen in her hands. Fortunately, a pharmacist was watching her and wondered why she would buy both products. Had he not intervened, she probably would have given both to her children, possibly harming them if she gave them too much acetaminophen over a long period, which has been shown to cause liver damage.
Mom had no idea that both medicines contained the same ingredient. She just knew that she wanted her kids to have acetaminophen for their sore throats and Triaminic for their cold symptoms. The statement on the box about the Triaminic being a fever reducer and the yellow highlighted “acetaminophen” (see photo) did not prevent her mistake, and did not signal that this Triaminic was different than the one she’d come to know.
Don Sapatkin
When the time is right, and you’re ready to slip into something a little more, er, comfortable, would she prefer . . . a rubber ducky?
While it’s always smart to plan ahead in these amorous matters, now there’s a unique opportunity to choose the wrapper design for a whole new brand: the Philadelphia Condom.
Online voting for the five finalists pictured here goes through 11:59 p.m. Feb. 20.
Philly’s condom art contest, an idea pioneered by New York City to help make safe sex cool, drew 124 entries. A panel of artists and activists chose the finalists.
Robert Field
You must purchase health insurance. The government says so. That is the flashpoint of health reform – the individual mandate forcing everyone to buy coverage whether they want to or not.
Who concocted this idea? Was it wide-eyed liberals trying to replace the free market with a government-run system? Hardly.
The individual mandate was the brainchild of the Heritage Foundation, one of the most conservative think tanks in the country. They saw it as part of the salvation of free market health care.
You’d hardly know it today from the Foundation’s website. A recent visit to the homepage found news on the fight against Obamacare, with links to a page condemning health reform for its “mandates and federal control.” But do some searching on the site, and you’ll discover where the mandate idea actually came from.
- Abington Memorial Hospital
- Agency for Healthcare Research and Quality
- American Medical Association
- Aria Health
- Centers for Disease Control and Prevention
- Centers for Medicare & Medicaid Services
- Consumer Medication Safety site from ISMP
- Cooper University Hospital
- Crozer-Keystone Health System
- ECRI Institute
- Inquirer Health & Science
- Institute for Safe Medication Practices
- Jefferson Health System
- Kaiser Health News
- Kennedy Health System
- Lourdes Health System
- Medical Society of New Jersey
- Mercy Health System
- New Jersey Department of Health and Senior Services
- New Jersey Hospital Association
- NPR.org Shots
- NYTimes.com: Well
- Penn Medicine
- Pennsylvania Department of Health
- Pennsylvania Health Care Cost Containment Council
- Pennsylvania Medical Society
- Pennsylvania Patient Safety Authority
- St. Mary Medical Center
- Temple University Health System
- Tenet Healthcare
- The ACP Advocate Blog by Bob Doherty
- The Chester County Hospital
- The Hospital & Healthsystem Association of Pennsylvania
- U.S. Department of Health and Human Services
- U.S. Food and Drug Administration
- Virtua
- WSJ.com Health
