Archive for March, 2008

Hospitalization: Some Patient Rights

Thursday, March 27th, 2008

 

Many patient “rights” are simply pious clichés,for example, the right to a “Choice of Provider,” your right to “Access to Emergency Services,” your right to “Participate in Treatment Decisions” the right not to be discriminated against, the right to privacy (see the HIPAA Privacy Act), the right to complain and appeal, etc. There are over 8 million sites on Google where you can find endless lists of patient rights issued by Government, uncountable medical organizations, HMO’s, private hospitals (see this nice one from Abington Memorial Hospital in suburban Philadelphia), etc.

I had something different in mind when I drew up the following list. If you are a hospitalized patient you indeed have, among other rights, the following:

1. The right to exchange immediately the disgusting open-at-the-back hospital gown for your own nightgown, pajamas, and robe. You also have the right to a bedside commode, with assistance, if you cannot make it to the bathroom.

2. The right to refuse any inedible meals offered you, along with the parallel right of ordering your own meals brought in from outside – or in extreme cases reported – walking out of the hospital and going to the pizza parlor or Chinese takeout across the street. Item: The hospital earns a negotiated daily (per diem) rate from Medicare and most insurers, between $1,000-$2,000 a day for your care and feeding. Compare that with $200-$300 per day at The Hilton.

Other suggested, specific rights of refusal

a. You may refuse multiple blood lettings for tests during a single day because an intern or attending has a new inspiration following the writing of morning orders.

b. You may refuse to remain attached to an IV line or an oxygen tube or other apparatus long after the need for them exists. (For courtesy, and if you’re in bad straights, I suggest consulting your doctor first on this one.)

c. You can refuse to be awakened at night for sleeping pills. (Or you can at least chew out the nurse.)

d. You may refuse to be taken anywhere else in the hospital without being told first where you’re going, what you’re going for, and who ordered the trip. You cannot be forced or coerced into taking any medication, including injectables with which you are unfamiliar or about which you are concerned.

e. Make sure you are properly identified before you receive medications or are transported anywhere. Believe it or not, misidentification of patients as well as medical orders for treatment or tests are still among the most prevalent and egregious hospital errors.

f. General right of refusal includes your right to challenge any treatment, diagnostic test, specific therapy, or other procedure of which you have no knowledge or have any unanswered questions. Remember these magic words which Must be obeyed when uttered: “I Refuse this (service)”, otherwise you may be manipulated or bamboozled into passivity and acceptance.

While this list of “rights” has a strong scent, it merely expresses a common sense approach to be applied whenever you have concerns, misgivings, or queries. If followed mindlessly and without tact, some of these “rights” may be counterproductive, irritating physician and staff. Still, in a reasonable universe, hospital staffs should be compelled to treat patients with exceeding respect and calm consideration.

Nothing can justify inconsiderate treatment of patients. When people find themselves sick in a strange environment, they are absolutely dependent on the kindness, let alone competence, of strangers.

Another House Call

Friday, March 21st, 2008

Many years ago, even before rapid-acting diuretics like Lasix and telephone numbers like 911 had been introduced, I was called to see a familiar patient, a 62 year old gentleman with diabetes, chronic heart and kidney failure, and COPD. When I got to the house about midnight he was struggling for air, having gone into pulmonary edema (sudden fluid backup in the lungs). I immediately started the then current standard treatment: oxygen, injectable morphine, and applied rotating tourniquets-used to reduce temporarily the load of blood returning to the heart. The patient responded rapidly, so that by the time the emergency vehicle arrived, it appeared he was out of immediate danger.

As the patient was being carried into the ambulance, the wife, an impassive somewhat abrasive lady who had witnessed many such medical close calls of her husband, asked, “Well, doc, how much do I owe you?” “Fifteen dollars,” I answered, the going rate for a house call in those days.

“For What?” she retorted. Being a bit exhausted and surprised at her seeming ingratitude, I answered sarcastically, “Just for saving his life.”

“Yeah, but for how long, doc?”

Payoffs to Othopedic Surgeons

Monday, March 17th, 2008

Recent disclosures have again uncovered direct financial ties between orthopedic surgeons and device manufacturers. A well-known spinal surgeon and some of the nation’s most prominent orthopedic surgeons, reporting their results in peer-reviewed journals, hailed Prodisc, an artificial spinal disk as superior to conventional spinal fusion. Dr. Jack Zigler, one of the lead researchers in a study of almost 240 patients made the claim, as did doctors at almost half of the 17 major and academic research centers involved in the study. Unfortunately, 11 of these researchers had more than a scientific interest in the study results; they stood to profit financially if the Prodisc succeeded, according to The New York Times (Jan. 30, 2008) and information from a patient lawsuit settled last year.

The field of spinal surgery continues to foster controversy, particularly in the treatment of back pain, where significant debate continues over how many patients actually benefit from spinal fusion and other operations. As artificial disks become a growth industry, more skepticism is unleashed. Thousands of patients worldwide have received the Prodisc, which costs about $10,00 in the U.S. Yet Medicare and several commercial insurers generally refuse to pay for the surgeries which can cost additional thousands of dollars. The legal and clinical aftermath of Prodisc continue in the courts, and includes patients who had the device implanted only months after the FDA approved it. The FDA is now checking to see whether there was adequate financial disclosure information about the Prodisc researchers during the clinical trial and when the the application for official approval was submitted.

New spinal devices are only the tip of the iceberg. Five companies that account for nearly 95 percent of the lucrative market in hip and knee surgical implants have avoided criminal prosecution over financial inducements paid to surgeons to use their products by agreeing to new corporate compliance procedures and federal monitoring under 18-month agreements with the U.S. Department of Justice.

According to the above Government web site, four companies, have executed Deferred Prosecution Agreements (DPAs), which will expire in 18 months if they meet all of their respective reform requirements. Criminal Complaints were also filed against those four companies, charging them with conspiring to violate the federal anti-kickback statute. Those Complaints will be dismissed at the conclusion of the DPAs if the companies comply with their terms. The fifth company, Stryker Orthopedics, Inc., voluntarily cooperated with the U.S. Attorney’s Office before any other company

Power Drinks:The Bottom Line

Wednesday, March 12th, 2008

The power drink market sounds piddling, only $18 billion a year compared to $70 a year for soft drinks.Yet this previously expanding market has been hurt by linkage of carbonated sodas to obesity. Makers like Coca Cola purchased Glaceau, the maker of vitamin water, are upgrading to new and ever more intensely promoted voodoo health drinks, e.g. Coke with Diet Coke Plus and there’s Full Throttle®, Pepsico with Tava®, Nestlé and Coke with Envige®, and Anheuser Busch, makers of Low Calorie 180 Blue® with Açaí “which uses only the highest quality ingredients, including carbonated water, vitamins B6, B12, C , …A serving of açaí berries has 80% RDA of antioxidants and it is said to contain 33 times more antioxidants than red wine grape.” Literally hundreds of sports and power beverages adorn the soft drink aisles of your favorite supermarket: Max Velocity, Rockstar®, Monster, Sobe No Fear®, Red Bull® among others, most with various vitamins, minerals, amino acids (taurine, carnitine, arginine,) caffeine, and ginseng or other herbals, of which many I have not heard. Retail prices are steep with Monster at $1.99 for 16 oz., Max Velocity® at $1.49 for 8 oz, and Red Bull® at $1.99 for 8.3 oz.. It reminds me of the cost of upscale bottled water in the range of $3.00 or more per gallon. And we complain about the cost of gasoline! (Think how much money you throw out every week in a country where municipal tap water is almost invariably superior and safer than the bottled product.) Watch Full Movie Online Streaming Online and Download

What About The Buzz Factor?

Last January, Anheuser Busch rolled out a new product, Spykes, in two-ounce bottles in flavors like mango, lime, lemon, and chocolate. First there was Disney’s Champagne for Kids. However, unlike the kiddie Champagne that was “just for pretend,” Anheuser-Busch’s new Spykes has real alcohol – it’s a “premium malt beverage” with a 12% alcohol content. This has raised a lot of temperatures to the boiling point. The reason? People are worried that Spykes is aimed at teens, particularly during Prom and graduation season. Not only does the sweet drink arrive in nice flavors but it also comes in a tiny bottle that’s easily pocketed and therefore hidden from a parent’s or chaperone’s watchful eye. Even though Spykes can only be sold in liquor stores the authorities are worried about reckless marketing to teens. It’s meant to be drunk straight or used as a mixer with beer or a cocktail. According to the new brand’s web site, “It’s whatever you want it to be.”

The evidence suggests that power drinks are little more than juiced up voodoo beverages containing sugar, carbonated water, caffeine, and a variety of mineral and vitamin supplements, generally of minimal amount, marketed with glittery packaging and seductive names. The only problem is the presence in many drinks of a variety of herbal compounds, ill-defined as to composition and quantity. Some, perhaps very few, are a health hazard, if consumed to excess. Yet it would certainly seem prudent to attempt deciphering the label before spending extravagantly for a can full of “power, health, and energy.” If you want a lift, what’s wrong with a cup of well-brewed coffee, or even a superannuated-read “plain” or “classic”- Coke or Pepsi?

The Company, the Drug, and the Celebrity:Pfizer, Lipitor, and Dr. Jarvik

Wednesday, March 5th, 2008

Pfizer has finally come under attack for its long-running ad campaign using the artificial heart pioneer Dr. Robert Jarvik as pitchman for its “anti-cholesterol” drug Lipitor. In the past two years Pfizer has spent more than $258 million in seeking to protect its market for statin drugs from the encroachment of the much cheaper generic, Simvastatin, Merck’s old Zocor. No wonder Pfizer was worried. In 2006 Lipitor was the top selling drug in the U.S., and was among the leaders in drug sales throughout the world.

Congress finally got into the act when the House Energy and Commerce Committee early this year decided to investigate the use of celebrity endorsements in marketing prescription drugs directly to consumers. Jarvik is Celebrity No. 1 on the list. “In the ads, Dr. Jarvik appears to be giving medical advice, but apparently, he has never obtained a license to practice or prescribe medicine,” John Dingell (D-Mich.), chairman of the Committee revealed. Nor did he ever take an interneship or residency. Nonetheless, Jarvik’s presence appears to have helped shore up Lipitor sales, which were $13 billion in 2006.

 

Dingell and company asked Pfizer CEO Jeff Kindler to submit all records of the advertising campaign for Lipitor involving Jarvik, any financial records or other associations between the doctor and the company.

Finally, it was revealed that the Lipitor campaign was a deception from the start. Pfizer’s original TV commercial showed Jarvik rowing a racing shell across what appeared to be a mountain lake when in fact a stunt double was at the oars. Dr. Jarvik apparently does not row. Moreover, the ads fail to note that he only began taking Lipitor a month after he started shilling for Pfizer under a contract that would pay him a minimum of $1.35 million over two years.

Rather than take on the Committed, Pfizer instead decided to take a powder and recently ended the Lipitor advertising campaign. According to news reports the committee plans to continue its investigations of the Lipitor marketing campaign and of possible other deceptive advertising of prescription drugs to consumers.

As many critics of Big Pharma are aware (see my blog of Feb. 14, 2008), “DTC” or Direct to Consumer Advertising is the problem, not just celebrity endorsements. Until the U.S. makes drug promotions to the public illegal, as it is in virtually every major country, we will continue to suffer from the “Jarvik/Lipitor Effect.”