Could cameras in operating rooms reduce preventable
Chris Nowakoskiâ€™s wife died in Wisconsin during what should have been a
routine procedure on her pacemaker. Danny Longâ€™s wife in North Carolina
suffered catastrophic neurological injury during a surgery to relieve
numbness in her extremities. A doctor perforated the colon and esophagus of
Deirdre Gilbertâ€™s daughter in Texas, then operated on her after she was
In each case, the families still donâ€™t know the full story of what happened
to their loved ones because of a lack of documentation and an inability to
pursue a costly lawsuit. They are relatives of an estimated 400,000 a year
people who die in the United States of preventable medical errors, the
third-leading cause of death after heart disease and cancer. But the
families say they could have known much more if cameras had been installed
in the operating rooms, recording the actions and movements of the doctors
and staffers involved.
They are enthusiastic supporters of a growing movement that is seeking to
require hospitals and surgical suites to have video and audio recording
capability. Now, a surgeon in Toronto has built a â€śblack boxâ€ť that
synchronizes a patientâ€™s physical data with video and audio recordings of an
operation, enabling doctors to review their work the same way athletes watch
video of their performances. And he said he has lined up two U.S. hospital
systems to take part in the first testing of the system.
A bill that would require cameras in every operating room in Wisconsin has
been introduced in the state legislature, and supporters say that lawmakers
in other states are closely watching the billâ€™s progress. The proposed
legislation, known as the â€śJulie Ayer Rubenzer Law,â€ť is named for a
Wisconsin woman who died after she was given excessive amounts of propofol
during breast-enhancement surgery.
Rubenzerâ€™s brother, Wade Ayer, founded the National Organization for Medical
Malpractice Victims and helped draft the bill, which is supported by
patient-advocate groups around the country. Ayer said video and audio
recordings can capture the reasons behind â€śadverse events,â€ť as the medical
industry terms them, and deter inept or simply bad behavior by medical
personnel â€” such as the anesthesiologist in suburban Washington who can be
heard harshly criticizing her patient in an audio recording made by the
patient. The physician was hit with a $500,000 jury verdict.
Currently, re-creating what went wrong in an operating room involves a
mixture of memories and whatever notes were taken at the time or shortly
afterward, a vague combination that vexes families trying to get to the
truth about a failed procedure or a fatal complication. Recording surgeries
â€śoffers transparency, truth and accuracy,â€ť Ayer said, â€śin collecting data
for the medical record and testimony. It offers data and insight for medical
boards and even prosecutors. It offers oversight and policing.â€ť
But the healthcare industry has flexed its muscle where needed, sometimes
driven by concerns about the effects that video recordings could have on
medical malpractice lawsuits as well as the cost of installing and
maintaining complex recording systems. A bill in Massachusetts that would
require hospitals to allow recording by a licensed videographer, at the
patientâ€™s expense, has repeatedly failed in recent years in the face of
opposition from hospitals, according to news media reports.
Ayer has also begun lobbying members of Congress in order to judge interest
in a federal law regarding surgical cameras. He also is pushing for a
national database of doctors who have had their licenses taken away after
they made medical errors. The license of the doctor whose actions killed
Ayerâ€™s sister was revoked in Florida, but he now practices in Pennsylvania,
public records show.
Some advocates for operating-room cameras say the devices can only help.
They add that tort reform in many states limits damages in malpractice
cases, discouraging lawyers from taking on cases without clear-cut evidence
â€” such as video.
Visit the Washington Post for the story.
vaccine a step closer as scientists create experimental jabs
A universal flu vaccine that protects against multiple strains of the virus
is a step closer after scientists created experimental jabs that work in
The vaccines prevented deaths or reduced symptoms in mice, ferrets and
monkeys infected with different types of flu, raising hopes for a reliable
alternative to the seasonal vaccine.
Doctors hope that a universal flu vaccine would do away with the need for
people at risk to have flu jabs every year, and even protect the public from
dangerous, potentially pandemic, strains that jump from birds or pigs into
Conventional flu vaccines target the â€śheadâ€ť of a molecule called
haemagglutinin (HA) that sits on the surface of flu viruses. But because the
head of the HA mutates so rapidly, seasonal flu vaccines must be continually
re-formulated to ensure they are effective.
During the last flu season, mutations in the HA molecule on one of the most
common circulating strains, H3N2, meant that the seasonal flu
vaccine offered little protection. Public Health England said in February
that the less effective vaccine was likely to have been behind a steep rise
in flu deaths.
In two studies reported on Monday, separate research teams describe how they
created novel flu vaccines that target the â€śstemâ€ť of the HA molecule instead
of the head. The stem of the HA molecule is similar across different flu
strains and mutates far less often.
One of the teams, led by Barney Graham at the National Institutes of Health
in Maryland, created their vaccine by attaching part of a flu virusâ€™s HA
stem to tiny balls of protein. These protein nanoparticles kept the stem
intact and made it easy for the immune system to spot once it was injected.
In lab tests, one version of the vaccine completely protected mice and
partially protected ferrets from injections of H5N1 bird flu virus, which
was fatal in unvaccinated animals. The H5N1 flu strain has killed more than
400 people since 2003, most of whom caught the virus from infected poultry.
A second team, led by Antonietta Impagliazzo at the Crucell Vaccine
Institute in Leiden, created their own experimental flu vaccine by removing
the head of the HA molecule, and tweaking the stem to make it bind to
antibodies more effectively.
Visit the Guardian for the report.
Surgeon who wrote
of becoming killer is denied bail reduction
Long before he faced lawsuits and criminal charges, a North Texas
neurosurgeon emailed one of his employees.
â€śI am ready to leave the love and kindness and goodness and patience that I
mix with everything else that I am and become a cold blooded killer,â€ť
Christopher Duntsch wrote.
To authorities, the chilling Dec. 11, 2011, email points to Duntschâ€™s
mind-set in the months before he â€śintentionally, knowingly and recklesslyâ€ť
botched spinal surgeries, severely injuring four people and killing one
woman, Floella Brown, who died in July 2012.
The email was among new evidence Dallas County prosecutors presented against
Duntsch at a hearing Friday in which Criminal District Judge Carter Thompson
refused to reduce Duntschâ€™s $600,000 bail.
Duntsch, 44, was arrested July 21 on five counts of aggravated assault
causing serious bodily injury and a count of injuring an elderly person. He
performed those procedures at Dallas Medical Center, South Hampton Community
Hospital and University General Hospital.
Dallas police said in a search warrant affidavit that he is also under
investigation in the botching of at least 10 other patientsâ€™ surgeries in
Plano and Dallas that occurred from November 2011 through June 2013. Duntsch
â€śknowingly takes actions that place the patientsâ€™ lives at risk,â€ť police
said, such as causing extreme blood loss by cutting a major vein and then
not taking proper steps to correct it.
In one case, Duntsch left a surgical sponge inside a man's body. During that
same surgery, another doctor forced him to stop operating because of his
â€śunacceptable surgical technique,â€ť the affidavit said.
Duntschâ€™s medical license was revoked in December 2013 after the Texas
Medical Board found he had a pattern of failing to follow proper procedures
before operations or respond to complications that caused at least two
Visit the Dallas News for the story.
No, you do not
have to drink 8 glasses of water a day
If there is one health myth that will not die, it is this: You should drink
eight glasses of water a day. Itâ€™s just not true. There is no science behind
it. And yet every summer we are inundated with news media reports warning
that dehydration is dangerous and also ubiquitous.
These reports work up a fear that otherwise healthy adults and children are
walking around dehydrated, even that dehydration has reached epidemic
Letâ€™s put these claims under scrutiny. Water is present in fruits and
vegetables. Itâ€™s in juice, itâ€™s in beer, itâ€™s even in tea and coffee, and no
coffee isnâ€™t going to dehydrate you, research shows thatâ€™s not true either.
The human body is finely tuned to signal you to drink long before you are
actually dehydrated. Contrary to many stories you may hear, thereâ€™s no real
scientific proof that, for otherwise healthy people, drinking extra water
has any health benefits. For instance, reviews have failed to find that
thereâ€™s any evidence that drinking more water keeps skin hydrated and makes
it look healthier or wrinkle free.
It is true that some retrospective cohort studies have found increased water
to be associated with better outcomes, but these are subject to the usual
epidemiologic problems, such as an inability to prove causation. Moreover,
they defined â€śhighâ€ť water consumption at far fewer than eight glasses.
Prospective studies fail to find benefits in kidney function or all-cause
mortality when healthy people increase their fluid intake. Randomized
controlled trials fail to find benefits as well, with the exception of
specific cases â€” for example, preventing the recurrence of some kinds of
kidney stones. Real dehydration, when your body has lost a significant
amount of water because of illness, excessive exercise or sweating, or an
inability to drink, is a serious issue. But people with clinical dehydration
almost always have symptoms of some sort.
There is no formal recommendation for a daily amount of water people need.
That amount obviously differs by what people eat, where they live, how big
they are and what they are doing. But as people in this country live longer
than ever before, and have arguably freer access to beverages than at almost
any time in human history.
Visit the New York Times for the article.
Rising cost of
prescription drugs threatens healthcare gains
According to a recent report from the Centers for Disease Control and
Prevention's National Center for Health Statistics, an unprecedented 90.8%
of Americans now have health insurance.
But because Obamacare is officially called the Patient Protection and
Affordable Care Act, the soaring cost of prescription drugs is well on its
way to making healthcare unaffordable again.
Prescription drug costs are rising dramatically in the United States. Based
on a recent survey by Consumer Reports, 33% of Americans were paying an
average of $39 more out of pocket for their regular prescription
medications, and 10% were paying as much as an extra $100. Among the drugs
that saw the highest increases were medications for asthma, high blood
pressure and diabetes, which went up by more than 10% last year.
For low-income and many fixed-income Americans, paying the rising cost of
prescription drugs means cutting back on daily expenses. And while it's one
thing to cut back on entertainment and restaurants, it's a whole 'nother
thing to cut back on groceries or rent payments.
According to the survey, one out of four people whose prescription drug
costs went up said they were unable to pay their medical or medication
bills. Seven percent said they missed a mortgage payment. One out of four
stopped getting their prescriptions filled, and one out of five skipped
scheduled doses. That is hardly a prescription for good health.
But the impact of these price increases goes far beyond the people who need
prescription drugs. The cost increases affect employers and insurers, who
are transferring some of these costs to consumers, requiring them to pay a
larger share through their monthly premiums and rising copays.
They also affect state Medicaid programs for the poor and Medicare programs
for people with fixed incomes.
So what can be done to rein in the cost?
1. Consumers, employers and insurance companies require much more
transparency on how much prescription drugs actually cost. The negotiated
rates between drug manufacturers and distributors are a well kept secret,
and if you don't know what a drug should cost, you can't tell if you're
2. Use generic drugs and get them through mail order, because even if your
employer is providing you with health insurance, your copays and deductibles
may be rising to the point where you can't afford to buy the brand-name drug
at the corner drugstore.
3. There is a need for more competition. The unfortunate fact is that three
major pharmacy benefits managers -- CVS Caremark, Express Scripts Inc. and
Prime -- negotiate rates between the manufacturers and pharmacies. And now
the major insurance companies are starting to merge, leaving even less
choice for consumers.
4. Drug manufacturers attribute their rising drug costs to massive
investments in research and development, but many critics say that's an
excuse for price-gouging. Gilead Sciences' Harvoni, a new medication to
treat Hepatitis C, costs $1,350 per pill -- $113,400 for a 12-week
treatment. Its predecessor, Solvaldi, cost "only" $1,000 per pill -- $84,000
for a 12-week treatment. Manufacturers are certainly entitled to cover the
costs of research and development, but releasing new drugs into the market
at a faster pace, depending on how quickly the FDA can accelerate its
approval processes, would increase competition and lower the cost of R&D.
5. Long-standing patents on medications often create barriers to developing
new ones, and they also delay access to generics. Shortening the expiration
of those patents would lower overall costs and might create an environment
that encourages more options for consumers.
6. Restrictions on purchasing prescription drugs in other countries and
bringing them to the United States -- both through travel and on the
Internet -- must be relaxed. This would drive up competition and encourage
the companies to lower their prices.
7. This is the big one: The largest purchaser of healthcare services in the
country is Medicare, but the law forbids Medicare officials -- unlike
Medicaid and Department of Veterans Affairs officials -- from negotiating
prices with pharmaceutical companies. That makes no sense whatsoever.
Changing this law has the potential to change everything.
Visit CNN for the story.
White House is
pressed to help widen access to Hepatitis C drugs
The Centers for Medicare & Medicaid Services has issued 2014 quality and
financial performance results showing that Medicare Accountable Care
Organizations (ACOs) continue to improve the quality of care for Medicare
beneficiaries, while generating financial savings. As the number of Medicare
beneficiaries served by ACOs continues to grow, these results suggest that
ACOs are delivering higher quality care to more and more Medicare
beneficiaries each year.
The results demonstrate significant improvements in the quality of care ACOs
are offering to Medicare beneficiaries. ACOs are judged on their performance
on an array of meaningful metrics that assess the care they provide â€“
including how highly patients rated their doctor, how well clinicians
communicated, whether they screened for high blood pressure and tobacco use
and cessation, and their use of Electronic Health Records. In the third
performance year, Pioneer ACOs showed improvements in 28 of 33 quality
measures and experienced average improvements of 3.6% across all quality
measures. Shared Savings Program ACOs that reported quality measures in 2013
and 2014 improved on 27 of 33 quality measures.
When an ACO demonstrates that it has achieved high-quality care and
effectively reducing spending of health care dollars above specified
thresholds, it is able to share in the savings generated for Medicare. In
2014, 20 Pioneer and 333 Shared Savings Program ACOs generated more than
$411 million in savings, which includes all ACOs savings and losses. The
results show that ACOs with more experience in the program tend to perform
better over time. Of the 333 Shared Savings Program ACOs, 119 are in their
first performance year in Track 1, which involves standing up the program
without the financial risk associated with later tracks.
The number of beneficiaries served by ACOs is likely to continue to grow.
Since the advent of the programs, the number of Medicare beneficiaries
served by ACOs has consistently grown from year to year, and early
indications suggest the number may grow again next year. The Shared Savings
Program continues to receive strong interest from both new applicants
seeking to join the program as well as from existing ACOs seeking to
continue in the program for a second agreement period starting in 2016.
Since passage of the Affordable Care Act, more than 420 Medicare ACOs have
been established, serving more than 7.8 million Americans with Original
Medicare as of January 1, 2015. For more detailed quality and financial
A new job hazard
for doctors is rising with India's economy
When an ailing 75-year-old woman succumbed to heart failure after two weeks
in intensive care, it fell to a young physician to break the news to her
sons. They did not take it well. One marched out of the suburban Mumbai
hospital and he soon returned with relatives, who attacked the doctor
outside the intensive care ward, leaving him with fractures in his nose and
foot as two dozen hospital staffers looked on helplessly.
The incident in April was one of a string of attacks on Indian doctors and
medical staff members, most of them by angry friends and relatives of
patients. The threats have become so serious that one doctorsâ€™ organization
this month enlisted an on-call private security company, whose website
features testimonials from Bollywood stars and political figures, to protect
4,000 of its members.
There is an increasing expectation from patients that with modern medicine
and technology, a doctor should be able to guarantee a good outcome.
Unlike their counterparts in the United States, where physical attacks on
medical professionals are rare, doctors in India appear to be at growing
risk. The Indian Medical Assn. found in a recent survey that more than
three-quarters of doctors had faced violence or verbal abuse at work.
The problem stems from a lack of trust between patients' families and
doctors, industry groups say. As India's economy booms, the quality of
healthcare available to the aspiring middle class has increased, along with
its cost. That has made it more difficult for people to accept when patients
don't get better.
At the same time, tales of corruption and carelessness at medical colleges
and among practicing doctors have spread through the country, prompting
growing skepticism among Indians of a profession that has long been revered
Healthcare advocacy groups complain that Indian medical schools don't teach
communication skills, producing graduates who can't explain procedures in
plain language. Worse, some doctors have been found trying to pad their
earnings by performing unnecessary procedures or ordering excessive tests.
Since the vast majority of Indians pay out of pocket for healthcare, they
wind up footing the inflated bill.
Doctors, especially in government hospitals, counter that they are
overworked and underpaid. Shoddy medical infrastructure, including a dearth
of well-equipped emergency vehicles, means that many patients reach
hospitals too late to be saved.
Doctors say a 2010 law mandating punishment for attacks on medical workers
in the western state of Maharashtra, which includes Mumbai, has not been
enforced. They also complain about entitled attitudes of patients,
particularly in places such as Panvel, a onetime agricultural area that is
now a boomtown suburb, bursting with giant apartment blocks. As land prices
soar, farming families have become urbanites almost overnight, often
harboring what doctors say are unrealistic expectations.
Visit the Los Angeles Times for the story.
vasculitis diagnosis may save vision
The implementation of a "fast-track" clinic with rapid ultrasound assessment
for patients with suspected giant cell arteritis led to a dramatic decrease
in permanent visual impairment, a Norwegian study found.
Among 32 patients evaluated conventionally using biopsy of the temporal
artery and 43 assessed with the fast-track ultrasound approach, 18 patients
-- nine patients in each group -- experienced visual disturbances typical of
giant cell arteritis, such as diplopia, blurred vision, and amaurosis fugax,
according to Andreas P. Diamantopoulos, MD, PhD, of the Hospital of Southern
Norway Trust in Kristiansand, and colleagues.
Yet six patients in the conventional group (21.5%) experienced permanent
visual loss compared with only one assessed with the fast track ultrasound
approach (2.4%), with what was an 88% lower rate, the researchers reported
online in Rheumatology.
Giant cell arteritis is the most common of the primary vasculitides, most
often affecting individuals older than 50. One in five patients are thought
to experience irreversible vision loss, and high-dose steroids are the
treatment of choice.
The gold standard for diagnosing the condition has been biopsy of the
temporal artery, with confirmation being provided by a positive response to
corticosteroid therapy. However, the inflammation of the artery typically is
segmental and so can be missed if the biopsy needle is inserted in areas
unaffected by the vasculitic process.
In addition, delay in obtaining the biopsy is common and clinicians may
hesitate to prescribe corticosteroids in high doses to older patients, yet
speed is of the utmost importance as vision loss can occur rapidly.
"The fast-track approach has been introduced in several fields in medicine
with remarkable success in reducing mortality, morbidity, and inpatient days
of care. Rapid initiation of treatment improves outcomes in rheumatoid
arthritis through the utilization of the window of opportunity," the
Visit MedPage Today for the study.