Health Care’s Trick Coin
By BEN GOLDACRE
LONDON
THIS month, Johnson & Johnson is facing more than 10,000 lawsuits over an artificial hip that has been recalled because of a 40 percent failure rate within five years. Mistakes happen in medicine, but internal documents showed that executives had known of flaws with the device for some time, but had failed to make them public.
It would be nice to imagine that this kind of behavior is exceptional, but in reality, the entire evidence base for medicine has been undermined by a casual lack of transparency. Sometimes this is through a failure to report concerns raised by doctors and internal analyses, as was the case with Johnson & Johnson. More commonly, it involves the suppression of clinical trial results, especially when they show a drug is no good. These problems would be bad enough on their own, but they are compounded by a generation of “fake fixes” that have delivered false reassurance, and so prevent realistic public discussion.
The best evidence shows that half of all the clinical trials ever conducted and completed on the treatments in use today have never been published in academic journals. Trials with positive or flattering results, unsurprisingly, are about twice as likely to be published — and this is true for both academic research and industry studies.
If I toss a coin, but hide the result every time it comes up tails, it looks as if I always throw heads. You wouldn’t tolerate that if we were choosing who should go first in a game of pocket billiards, but in medicine, it’s accepted as the norm. In the worst case, we can be misled into believing that ineffective treatments are worth using; more commonly we are misled about the relative merits of competing treatments, exposing patients to inferior ones.
This problem has been documented for three decades, and many in the industry now claim it has been fixed. But every intervention has been full of loopholes, none has been competently implemented and, lastly, with no routine public audit, flaws have taken years to emerge.
The Food and Drug Administration Amendments Act of 2007 is the most widely cited fix. It required that new clinical trials conducted in the United States post summaries of their results at clinicaltrials.gov within a year of completion, or face a fine of $10,000 a day. But in 2012, the British Medical Journal published the first open audit of the process, which found that four out of five trials covered by the legislation had ignored the reporting requirements. Amazingly, no fine has yet been levied.
How to make the most of your doctor’s appointment
Posted Jan. 31, 2013, at 12:02 p.m.
Medical appointments are pretty short these days. Before you know it, the visit is over and you’re out the door. Time can run out before your most important issues or concerns are addressed.
The National Institute on Aging has suggestions to make the most your doctor’s visit.
First, make a list of your concerns and prioritize them. This is the best way to maximize the limited and valuable time you have with your health care provider and ensures you will remember everything you want to discuss. Use bullet points with the most important item at the top and try to stay focused, which can be hard in that environment. Most of all, don’t put off the things that are really bothering you until the end of your appointment — bring them up first.
Bring information about any drugs you are taking, either written down legibly with the dosage included or grab a bag and put all your medications in it. This includes the prescriptions you take, as well as over-the-counter medicines, vitamins and herbal remedies or supplements. Sometimes the visual of seeing a bag full of various medications can be striking for a provider.
However, don’t bring any medication that requires refrigeration; instead, write the name and dosage down and put the paper in the bag so you don’t forget it. This is also a good time to check the bottles for refills.
Don’t forget your insurance cards and names, contact information and medical reasons for any other doctors you see.
If you have trouble seeing or hearing, let the staff and doctor know. If you have glasses for reading, bring them and be sure any hearing aids are in good working order. Everyone is rushed, so simply saying, “My hearing makes it hard to understand everything you’re saying. It helps a lot when you speak slowly,” can make a big difference in your comprehension.
Lastly, consider bringing a family member or friend. Two heads are better than one and your buddy can take notes for you to review later. This is your time, short though it is. Make the most of it. Log on to www.nia.nih.gov for more information.
http://bangordailynews.com/2013/01/31/health/how-to-make-the-most-of-your-doctors-appointment/print/
Lincoln hospital might drop ambulance service to 14 towns
Posted Jan. 29, 2013, at 3:46 p.m.
LINCOLN, Maine – Penobscot Valley Hospital is considering dropping the ambulance service it provides to 14 northern Penobscot County towns, hospital Chief Executive Officer David Shannon said Tuesday.
“We are looking at our options for the ambulance service at this point. Either we maintain it or get rid of it,” Shannon said. “The ambulance for us is sort of a secondary service to providing hospital care. It is difficult for us to find people to staff the ambulance.”
The service has also been losing money, Shannon said. He declined to say how much.
Penobscot Valley Hospital officials are having a study done of their options that they hope to have ready for the hospital Board of Directors meeting on Feb. 25, Shannon said.
Shannon said he doesn’t expect the future of the service to be decided immediately. Any decision would also take several months to implement, he said.
“We would not just turn it over to the towns,” Shannon said. “My anticipation is that we would meet with the surrounding town leaders if we were to leave the service” to give them a chance to digest the news and explore options.
When asked what Lincoln would do in response to the hospital leaving the ambulance business, Town Council Chairman Steve Clay referred comment to interim Town Manager William Lawrence. Lawrence did not immediately return messages left Tuesday.
The ambulance service consists of two ambulances and support staff, handling about 1,200 calls a year, Shannon said. One of the ambulances is based in Howland and covers towns in that area.
Lincoln’s fire department does not offer ambulance service, but some northern Penobscot County towns have ambulances that handle emergencies or patient transfers between Penobscot Valley and other medical facilities.
Those towns include Millinocket, East Millinocket and Mattawamkeag.
Crisis time: How Maine can help remedy its child psychiatrist shortage
Posted Jan. 31, 2013, at 2:25 p.m.
Time after time, children and teenagers end up in pediatricians’ offices not with broken bones or the flu, but with extreme anxiety or depression.
Adolescents with mental health conditions are typically seen in primary care more than any other setting, even though primary care physicians are not fully trained to diagnose or treat mental illness, according to the U.S. Agency for Healthcare Research and Quality.
Still, it’s up to that doctor to know what to do: Does the child need psychiatric care? How can immediate help be provided?
Then the bigger question arises: If the child needs continuing care from a psychiatrist, is one available nearby — and soon? Especially in rural Maine, the answer often is no, and the consequences are dire.
The lack of child psychiatrists is a national problem — for areas with both large and small populations — especially considering that an estimated half of all lifetime cases of mental illness begin before age 14. But rural places struggle the most: It can take months for a young person to get to see a child psychiatrist. Too often, help comes too late.
In the same way that individuals can work to overcome a mental health diagnosis, though, Maine can and should work to remedy the shortage of child psychiatrists. Failing to properly diagnose or treat children with mental illness creates more developmental and learning hurdles for them and can cause wider harm to society.
Addressing the shortage will, essentially, require greater collaboration between medical fields.
One response to the lack of psychiatric care for children and adolescents has succeeded — allowing pediatricians to consult with child psychiatrists by phone when they have patients who need mental health help.
Massachusetts started the first such program in the country: the Massachusetts Child Psychiatry Access Project. When primary care clinicians have concerns about a patient with a possible mental health diagnosis, they contact the program and receive a return call from a psychiatrist, usually within half an hour. The psychiatrist can then either answer the primary care doctor’s questions over the phone, refer the doctor and family to other resources or set up a way to see the patient face-to-face.
The Massachusetts program is fully funded by the state and provides coverage for roughly 96 percent of children needing care. Maine has a similar initiative called the Child Psychiatry Access Program, but it operates only in the southern part of the state, was started with grant money and continues with funding from a philanthropist, which will end. The program works with eight practices and provides coverage for about 38,000 children and adolescents.
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