Healthcare Concerns

Archive for the ‘Health’ Category

Story By: by Ted Burnham

A health worker injects a woman with a shot of Depo Provera, a quarterly contraceptive injection, at a health clinic in Busia, Uganda, in 2009.

Women living with HIV, or at high risk of infection, should continue to use hormone injections to prevent pregnancy, the World Health Organization said Thursday.

But the advice stressed that couples should use an additional protective method, like condoms, to prevent HIV transmission between partners.

The update comes after an expert review of data on the link between hormone injections and HIV transmission. A study in Lancet Infectious Diseases last year found that hormone injections nearly doubled the chance that a woman would pass HIV to her partner, or contract it from an infected partner, as Shots reported.

The study was particularly worrisome for African communities, as NPR’s Richard Knox reported. Hormone injections are the most popular form of contraception in Africa, which according to a 2009 UN report is also home to 23 million people living with HIV or AIDS — almost 70 percent of the world’s total.

That put public health officials in a bind. Unintended pregnancies carry lots of risks, so women’s access to contraception is a high priority. And hormone injection is particularly convenient for African women. It’s discreet, lasts for months and there are no pills to keep track of.

But HIV prevention is also a major concern, and it wasn’t immediately clear how health officials would pursue both goals.

At the end of January, WHO convened a panel of 75 experts from 18 countries to go over all of the relevant scientific literature on hormone injections and HIV.

They concluded that women in at-risk populations should continue using hormone injection to prevent pregnancy, in keeping with WHO’s 2009 guidelines.

But the panel reiterated that condoms are the most reliable method for preventing both HIV and pregnancy, so couples in which one partner is infected should always use a condom, regardless of their use of other contraceptives.

Yesterday’s statement confirmed that WHO’s Guidelines Review Committee had accepted the panel’s recommendations, but did not shed much light on the basis for the decision.

Shots turned to Amy Tsui, professor at Johns Hopkins Bloomberg School of Public Health and director of the Bill and Melinda Gates Institute for Population and Reproductive Health, for help understanding the decision.

Tsui, who was not involved in the deliberations, says the literature hasn’t provided solid evidence that hormone injections really do increase HIV risk.

“Some of the issues have to do with the usual science banter” about study design, both in the Lancet study and in others, Tsui says. While some studies have found a link, she says, others have not. Few of the studies were designed specifically to test for that relationship.

Tsui agrees with the WHO’s support for further research into the possibility that the risk is real. But for now, she says, “on the whole it looks safe.”

There are 40,000 individual stories from the women in Britain with PIP implants.

Debbie Lewis is one of them and she agreed to let us film her replacement surgery.

The 43-year-old hairdresser from Buckinghamshire decided to have implants about eight years when she and her husband separated.

She said: "I always wanted bigger boobs and when we separated I thought I'm going to treat myself."

The original surgery cost her £4,000 and within a year or so she'd had the implants changed twice.

This was because she experienced a known side-effect called 'capsular contraction', when the tissue around the implant hardens causing discomfort and distortion.

In November 2011 Debbie noticed a lump under her arm. She was told one of her implants had leaked into a lymph node.

Soon afterwards the PIP scandal erupted, with the French Government recommending all women there to have them removed.

Debbie says she could have opted to have her implants removed under the NHS -but it would have taken too long to organise.

She also said that she has lost so much breast tissue from previous implant replacement that she felt she had no option but to have new implants.

Her surgery cost £6,000 and she is not sure how she will pay for it.

"I have taken out two credit cards and I will have to worry about that later – what was crucial for me was to get these disgusting things out of me."

Her operation lasted one and a half hours. The swollen lymph nodes were removed and then the ruptured implant was taken out. Cosmetic surgeon, David Crawford said: "The implant shell looked like a thin beach ball. It was not a good quality product."

The silicone filler from the ruptured implant had turned yellow and begun to break up. By contrast the second implant emerged intact and undamaged. This underlines the dilemma facing women.

If scans suggest their implants are intact, should they opt for surgery? This is what's recommended by the French government, as a precaution. But a committee of experts here has suggested there is no need for routine removal

Debbie Lewis says she accepts that many people will have little sympathy for women who had PIP implants for breast enlargement – just one in 20 patients in Britain had the implants for reconstructive surgery following cancer.

The British Association of Aesthetic Plastic Surgeons has called for a ban on advertising for cosmetic surgery and said that it preyed on women in a vulnerable state, such as following a divorce.

"Rubbish" is Debbie Lewis' response. Despite all the problems she does not regret having surgery. "They've given me a lot of pleasure and self-confidence, for example going on the beach in my bikini."

She says she is looking forward to life without PIP implants and will now campaign to highlight the plight of women affected by the scandal.

Talks between ministers and medical leaders have taken place over concerns about changes to the NHS in England.

The BBC also understands some colleges are not convinced a hardening of their position is the right move. The Royal College of Surgeons has made it clear it would not sign up to the draft statement.

The academy, which in the autumn said it had serious concerns about the plans, particularly in the areas of accountability, competition and training, is now due to meet the three key health unions on Thursday night.

The academy confirmed it had had discussions about its "continuing concerns", but would not be making a statement at the moment.

But the government has indicated it was ready to push ahead with the changes regardless of what happens.

A Department of Health spokesman said: "There will always be some people who oppose changes to the status quo in the NHS.

"We have listened and we have made changes which have been widely welcomed including by professional bodies. But this process cannot go on forever. Changes are needed and we want the NHS to be able to make them in the interests of patients."

The developments came after the prime minister and Labour leader Ed Miliband clashed during Prime Minister's questions on Wednesday.

Mr Miliband said it was time for the bill should be scrapped.

Story By: by Jenny Gold

Dr. David Gross, medical director of the sleep lab at the National Rehabilitation Hospital in Washington, D.C., says more than three-quarters of the patients who come to his lab are diagnosed with apnea.

But the testing isn’t cheap: Each night at a hospital sleep lab can cost $1,900 and is usually mostly covered by a patient’s health insurance. Some patients end up spending two nights at the lab — one to test for apnea and the second to try the CPAP machine.

Dr. Fred Holt, an expert on fraud and abuse and a medical director of Blue Cross Blue Shield in North Carolina, says some patients aren’t having basic exams done first and are therefore being prescribed expensive tests they don’t need. Not everyone who snores has a chronic disorder, he says. In other cases, Holt says, the labs prescribe CPAP machines right away without first suggesting other strategies that could reduce apnea, such as losing weight or sleeping on your side.

“We are spending more and more money on sleep testing and treatment,” he says, “and like anything else in health care, there are unscrupulous people out there who are more than happy to do testing and treatment that might be of questionable value. This might be because of naiveté on the part of the physician, or unfortunately, it could be done for the sake of improving the cash flow of the business.”

It’s no secret that the sleep business can be lucrative for physicians. A website for Aviisha, a sleep testing company, has a special page for physicians showing a picture of a doctor with a stack of money in his lab coat pocket. And in February, the American Academy of Sleep Medicine is offering a seminar on the “business of sleep medicine for physicians” at a golf resort in Arizona.

While many sleep centers offer comprehensive care for sleep disorders, others are largely focused on overnight sleep testing, according to Dr. Nancy Collop, president of the academy. “A lot of people have gotten into the sleep business specifically to do that procedure,” she says. The goal of the academy’s accreditation process, she says, is to make sure sleep labs are offering more, because “many patients may not even need a sleep study.”

Helen Darling, president of the National Business Group on Health, which represents large employers offering health insurance to their workers, says the tests are driving up the cost of premiums. “This is a good example of something where we have technology, we have financial incentives to use more of it then we’ve historically done. You have enough problems, including a growing obesity epidemic, and you sort of put together the so-called perfect storm for driving up overuse and health care costs.”

Doctors should focus instead on common-sense approaches to sleep apnea, she says, like losing weight, before turning to expensive testing and medical devices.

Another option is a home sleep test, which costs less than a fifth as much as a lab test, and is considered effective for most patients. Medicare began paying for home sleep tests in 2008, but the tests have had only modest growth.

“I believe lab tests, as opposed to the home tests, are being wildly overprescribed,” says Michael Backus, senior vice president of American Imaging Management, a subsidiary of WellPoint.

Right now, 99 percent of the sleep tests given to WellPoint patients are done in the lab, he says, but “it should be 70 percent at home and 30 percent in the lab.” Backus adds that the majority of patients who are diagnosed with apnea and then given CPAP machines stop using them within the first year.

Some insurers, including WellPoint, are changing the way they pay for sleep testing to curb the costs. Many now require a special pre-authorization. They also ask the doctor whether a patient qualifies for a home sleep test instead of one at the lab. Those changes are now widespread among Massachusetts insurers and are having an effect on the sleep industry in the state.

Dr. Lawrence Epstein, the chief medical officer of Sleep HealthCenters in Massachusetts, says the labs have already experienced a 20 percent drop in the number of patients coming in for testing. While the past decade was focused on industry growth, he says it’s “now going to be about consolidation and provision of better quality, more efficient care.”

Sleep HealthCenters has shut down three of its 15 sleep labs, and more closures may be on the way. Epstein says the company is focusing more on “sleep wellness,” including treating and managing sleep disorders, and less on testing. The key, he says, is to become more efficient without decreasing access to care for patients who need it.

Story By: Steve Inskeep and Julie Rovner

Several steps in the 2010 health care overhaul law have been implement. But what impact will the presidential election and the Supreme Court have on it?

Story By: by Michelle Andrews

If patients and doctors both have easy access to the notes the doctor takes during their office visits, will it change their behavior?

That’s a question that an experiment called OpenNotes aims to answer by letting patients of more than 100 primary care doctors in three states see the notes online.

In December, researchers reported the results of surveys taken before the project started in 2010 in which patients and physicians were asked about their attitudes toward making such information available.

Published in the Annals of Internal Medicine, the study found that while patients were very gung ho to see the notes — more than 90 percent expected them to be helpful — physicians were much likely to think that notes sharing was a potential Pandora’s box of trouble.

“Notes are the things people never see,” says Jan Walker, a nurse at Beth Israel Deaconess Medical Center in Boston and the study’s lead author. “Yet if you have a lab result or a radiology result, the notes are the information that provides context for why this was done in the first place.”

OpenNotes is funded by the Robert Wood Johnson Foundation, which also is an underwriter of NPR.

Researchers are still analyzing the results of the year-long study. But Walker says what’s beginning to emerge is that the effect of seeing physician notes in black and white can be huge. A notation describing a patient as “obese,” for example, may be much more effective than a physician’s verbal instruction to lose weight at bringing home the seriousness of a problem and the need to do something about it.

“It’s very motivating,” says Walker. Seeing the doctor’s notes can help remind a patient about what was said during a visit that may have been fraught with anxiety. Instead of having to rely on a patient’s vague description of the appointment, office visit notes can give caregivers the lowdown on someone’s health.

“Someone comes home and says the visit was fine, but the notes say their heart failure was a bit worse,” says Walker. It’s not necessarily all good, however. In the study, up to a third of participating physicians said opening up their notes might change the way they documented such sensitive topics as obesity, substance abuse, mental health problems or cancer. And about the same proportion of the doctors surveyed for the project decided not to take part in it.

Meanwhile, patients said they might withhold information that they didn’t want recorded in the notes. So in some instances, opening up the communication process could actually limit what gets communicated. Go figure.

Story By: by Gigi Douban

If there’s a test for it, chances are a storefront lab is eager to help you have it done.

- Michael Wilkes, professor of medicine, University of California, Davis

- Kevin Hein, a lawyer who represents lab franchisees

“It’s another way for people to take control of their own health and monitor stuff that they feel is important to monitor without always having to have a doctor involved,” Hein says.

And that’s what is dangerous, says Michael Wilkes, professor of medicine at the University of California, Davis. He says false alarms come with the turf.

“If you order enough tests, something will eventually come back positive,” Wilkes says. And without a doctor’s input, he says, that can send someone into a panic. What’s more, ordering tests can drive up health care costs. That’s because a positive result, Wilkes says, is usually followed by a doctor’s visit.

“And now a doctor most likely has to repeat the test. And then there’s a whole list of cascade of new tests to confirm or go against what the tests show,” he says.

But the main issue, critics say, is that lab franchises are in the business of selling tests — tests that doctors might never have ordered — based on profit.

“From a marketing standpoint it’s a good position to be in where you create a service, create a demand,” says Rodney Forsman, president of the Clinical Laboratory Management Association. “It becomes a consumable like Starbucks or bottled water.”

Forsman says he worries about the motives of those turning medical tests into a commodity. But as insurance companies ask patients to swallow a bigger chunk of lab costs, the lab franchise industry could grow even more in the coming years.

Story By: by Scott Hensley

If you’re bugged by cost problems you find in health care, you can draw attention to them (and blow off a little steam) by writing about them. And if you’re really lucky your work might help change things.

Who knows? You might even make a little cash. Essays from four people just won them $1,000 each in the second annual Costs of Care contest.

Costs of Care is a nonprofit group that’s trying to get doctors and other health professionals to be more thoughtful about health costs. The group gets some backing from insurers Blue Cross Blue Shield of Massachusetts and the Harvard Pilgrim Health Plan.

Now, with that out of the way, who won?

The patient winners:

Renee Lux of Connecticut explains how a CT scan that she could probably have done without triggered some expensive insurance complications. As Lux was shopping for health coverage for her healthy family of four, a broker told her there was a problem. She’d had a scan and a medicine prescribed within 30 days of applying for coverage, which made her “practically uninsurable.” She eventually got coverage but at $189 more per month than she would have otherwise spent, she writes. Next time, she’d ask if the test and prescription were really necessary.

Court Nederveld of Florida, who has only catastrophic insurance coverage, saved money on heart tests and blood pressure medicines by shopping around and pushing doctors to explain their prices. “It will be several years before Medicare is available to me and until that time I intend to challenge every prescription or procedure as to necessity and cost,” he writes.

The winners in the health professional category:

Molly Kantor of Massachusetts tells the story of a 65-year-old woman with heart failure and several other condition who didn’t want to be admitted to the hospital for treatment. The health clinic where Kantor, a third year med student, works one afternoon a week came up with an appropriate outpatient treatment plan, saving money and hassles.

Andrew Schutzbank of Massachusetts explains how a woman receiving an infusion of a $1400-a-day medicine to treat her pulmonary hypertension couldn’t be discharged from the hospital. An internal policy about patients taking the drug prevented her from being moved out of the expensive cardiac care unit, even though she had been using the drug without problems as an outpatient. And a move to rehab wasn’t an option because of the particulars about how the drug was paid for. Eventually, the woman’s doctors decided it was probably best to stop the medicine anyway. She was stable and having some side effects. While the decision was a valid medical one, he writes, “we would not have considered it if [it] were not for the cost factor of the medicine.”

The Costs of Care group says it will post the entries, including the winners, on its blog during 2012.

Story By: by The Associated Press

A lawsuit in which Texas accused Johnson & Johnson of plundering the state Medicaid program by overstating the safety of an expensive anti-psychotic drug and improperly influencing officials and doctors to push the medication has been settled for $158 million, a subsidiary of the health care giant and state officials announced Thursday.

Texas had been seeking up to $1 billion from the drug maker.

Janssen Pharmaceuticals, Inc., one of the J&J subsidiaries that had been sued, said in a statement it will pay $158 million in full resolution of all claims in Texas.

The settlement represents a resolution to claims brought by Texas for alleged Medicaid overpayment during the years 1994-2008, the company said.

“Janssen is committed to ethical business practices, and has policies in place to ensure its products are only promoted for their FDA-approved indications,” the company statement said.

Tom Kelley, a spokesman for the office of Texas Attorney General Greg Abbott, which was leading the case on behalf of the state, confirmed the settlement but declined further comment.

A court hearing in which the settlement was to be announced was pending Thursday morning. Testimony in the trial began Jan. 10.

A whistle-blower filed the lawsuit, then Texas joined it. The lawsuit is one of dozens of pending state and federal cases alleging illegal marketing practices and kickbacks in an effort to boost Risperdal over competing drugs. Risperdal is a pill for schizophrenia and bipolar disorder.

Lawyers for Abbott’s office and whistle-blower Allen Jones accused Johnson & Johnson and some of its subsidiaries of committing fraud against Medicaid, the joint state-federal health care program for the poor, by making false or misleading statements about Risperdal and its safety, cost and effectiveness compared to other drugs in the 1990s.

Risperdal is used to treat schizophrenia and bipolar disorder.

At the start of the trial, lawyers for the New Brunswick, N.J.-based health care giant had insisted the company did nothing improper in marketing the drug.

The lawsuit was originally filed in 2004 by Jones, a former employee of the Office of Inspector General in Pennsylvania, who said he learned of Johnson & Johnson’s actions in Texas while investigating similar claims in his home state. Texas joined the case in 2006.

Last year, a South Carolina judge ruled Johnson & Johnson must pay a $327 million civil penalty after a jury found it guilty of overstating the safety and effectiveness of Risperdal. In 2010, a Louisiana jury found the company violated that state’s Medicaid fraud act and awarded it $258 million in damages.

The company is appealing the Louisiana verdict and has said it will appeal the South Carolina verdict as well.

Story By: by Julie Rovner

Protesters against new regulations limiting abortion rights rally outside the Statehouse in Topeka, Kan., last Sept.

If it seemed like 2011 was a big year for laws restricting abortion, it was.

In fact, according to “Who Decides? The Status of Women’s Reproductive Rights In the U.S.,” the 21^st annual report compiled by the abortion-rights group NARAL Pro-Choice America, the 69 laws enacted restricting a woman’s reproductive rights were just one short of the record set in 1999.

“The bottom line here is that elections matter,” said NARAL President and CEO Nancy Keenan. “When you have a change of anti-choice politicians sitting in the statehouse, it affects women’s’ lives.”

In fact, the dramatic increase in laws restricting abortion and other reproductive health matters shouldn’t have come as much of a surprise given the results of the 2010 elections, noted NARAL Policy Director Donna Crane.

After the sweeping success of the Tea Party, only six states have governments where both houses of the legislature and the governor support abortion rights, while 19 states have a governor and majority of the legislature opposed to abortion.

The states that passed the largest number of abortion restrictions in 2011 all got new, anti-abortion GOP governors in 2009 or 2010: Florida, Arizona and Kansas.

Interestingly, however, those states don’t match the list of the top “pro-life” states as ranked today by the anti-abortion group Americans United for Life. AUL, which ranked states not just according to anti-abortion legislation but also issues including euthanasia, cloning and stem-cell research, put Louisiana, Oklahoma, and Pennsylvania at the top of its list. Bringing up the rear were Hawaii, California and Washington.

Meanwhile, the NARAL report shows that the 69 anti-abortion laws fell broadly into five separate categories.

1. Mandatory ultrasound laws. These laws, now passed by eight states, require a physician to perform an ultrasound on a pregnant women before performing an abortion, even if it is not medically indicated and the woman does not request it.

2. Abortion insurance coverage bans. These laws, now passed by 16 states, ban abortion coverage by private health insurers. Some apply to all health insurers in a state, some to the new health “exchanges” that will be created by the Affordable Care Act.

3. Nebraska copycat bans. In 2010, Nebraska banned most abortions after 20 weeks gestation, on the contested theory that it marks the point in pregnancy when a fetus can feel pain. So far at least five more states — Idaho, Indiana, Kansas, Oklahoma, and Alabama — have joined Nebraska in enacting similar laws.

4. Race and sex selection laws. These are laws that make it a crime for physicians to fail to ensure that abortions are not being done purely for race or gender selection reasons. Arizona passed such a law in March 2011, joining three other states that had older laws already on the books.

5. Affiliation bans. These laws seek to bar abortion providers (often, but not exclusively Planned Parenthood) from receiving state funds for family planning or other services. Three states passed new laws in 2011, bringing to 11 the number of states with such laws in place, although four are currently being blocked by court order.

And action is already heating up for 2012, say both sides. Several states are looking at “personhood” ballot amendments, which define life as beginning at fertilization. Such laws would not only ban all abortions with no exception, but also many forms of birth control.

Meanwhile, the Ohio Senate is expected to move early this year on a bill to ban abortion at the point the fetal heartbeat can be detected – about eight weeks into pregnancy. The bill passed the Ohio House last year.

That bill “would outlaw abortion at a point in pregnancy when most women aren’t even aware they’re pregnant,” said Kellie Copeland, executive director of NARAL Pro-Choice Ohio.

And it would almost certainly prompt a challenge to the Supreme Court’s landmark Roe v. Wade decision legalizing abortion. That decision marks its 39^th anniversary this Sunday.