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Health Policy

Hospitals Are Getting Bigger (And Not Just In Texas)

by Jen Jenkins, Market Analyst

Parkland Hospital in Dallas, Texas is gaining exposure, and it isn’t due to its plush newness, updated equipment, sophisticated technology, or a tragic event of 1963 (for readers who are familiar with the name “Parkland Memorial.”). Instead, Parkland is getting attention because each room in the hospital has been specifically designed to more effectively treat overweight patients, or more accurately, “the bariatric population.” This population is made up of patients who typically have a body mass index of 40 or higher and as the need to accommodate these patients has grown, so has the trend to redesign hospital rooms across the country.

According to Nancy Connolly, a senior executive at a hospital consulting group, “Most hospitals we are building are providing an increasingly larger percentage of rooms that can accommodate the larger person.” These changes are necessary due to the unique challenges obese patients tend to face: beds, wheelchairs, and other equipment need to be larger and sturdier which also means that door frames and the rooms themselves need to designed differently. This is now routinely kept in mind as old hospitals are updated and new hospitals are built.

Regardless of what this new trend may indicate, the overall idea moving forward is for hospitals to be designed with the “universal patient” in mind so that every single person may feel comfortable and accounted for. Many arguments can and are being made about what this means about our society, food consumption, economic issues, etc. However, in this scenario hospitals are simply doing what is necessary to be in a better position to care for patients in every way possible – which is undoubtedly their most pertinent responsibility.  According to an article featured in The New York Times, although this trend is being seen across the country, Parkland has done an especially remarkable job in its new design, which will likely be replicated here on out.

 

Zion’s New Hands

By Jen Jenkins, Market Analyst

We are inundated by new technologies and on an almost daily basis learn of awe-inspiring events in the medical and scientific communities; nevertheless, it remains a momentous occasion when something happens that will so radically change a person’s life. Eight-year-old Zion Harvey, who lost his arms and legs to a life-threatening infection at the age of two, made his way home this week with a brand new pair of hands. Under the care of Dr. Scott Levin and a transplant team at the Children’s Hospital of Philadelphia, Zion became the first child to ever receive a double hand transplant.

The history of this extensive operation is a short one. The first single hand transplant to achieve prolonged success was performed in Louisville, Kentucky in 1999. Since that time there have been hand transplants performed on adults around the world; however, that list of completed surgeries is still relatively short.

Zion endured 11 hours of surgery and has had extensive physical and occupational therapy several times a day since the July surgery, but there are still many challenges he will continue to face. After not having use of these extremities for years, Zion will need to reengage his brain to use his hands to their full ability. Despite that, Dr. Levin shared with NBC News just how remarkable this boy is: “Today he was playing with his action figures and baking cookies with a whisk, doing all sorts of things with his hands we never dreamed he would be able to do within a few weeks of surgery.”  See the full story here.

 

The Great Sugar Anomaly

by Jen Jenkins, Market Analyst

Sugar is a familiar substance to all of us, but the history of its unnatural counterpart may be less so. The first artificial sweetener, saccharin, was discovered by accident in 1879; due to sugar rationing during WWI and WWII the artificial sweetener found fame. It wasn’t until 1965 that Aspartame, the second major artificial sweetener, was developed.

Controversy began when Canada banned saccharin in 1977 because of studies indicating it caused cancer in rats. The FDA considered banning the sweetener as well but due to large demand a moratorium was placed on the ban and then extended seven different times. In 1991 Congress withdrew the ban completely. The bottom line in that decision: numerous studies have been done on these artificial sweeteners since questions were first raised in 1977 and none have been able to prove a correlation between human consumption and cancer. Thus, artificial sweeteners remain prevalent in the diet of many Americans today.

For a long time, since sugar was deemed “bad,” diet enthusiasts touted artificial sweeteners to be the holy grail of dieting without giving up a sweet tooth. However, as is the tendency with many fads, the tables turned and a new battle has been waged. Which is worse: Sugar or its artificial equivalent? Opinions are vast and varied. This article by a professor of pediatrics at Indiana University School of Medicine argues that despite having been attacked for decades as “harmful chemicals” there is no scientific link showing humans are harmed by consuming artificial sweeteners, whereas there has been significant scientific evidence that sugar is harmful to humans and their health.

No matter where you stand in the debate it is interesting to scroll through the comments section of these articles to view the different stances people are taking (many of them volatile). Due to an overwhelming response to the article mentioned above, the author responded to some questions here. Whether you are team sugar or team artificial sweetener the key word seems to be moderation, or not at all, so what’s with all the hostility?

The Physician Who Saved Countless Babies from Birth Defects

Dr. Frances Oldham Kelsey, who died last week at the age of 101, became a 20th-century North American heroine for her role in the thalidomide case, celebrated not only for her vigilance, which spared the United States  from widespread birth deformities, but also for giving rise to modern laws regulating pharmaceuticals.

In 1960, Kelsey was hired by the FDA in Washington, D.C. At that time, she was one of only seven full-time and four young part-time physicians reviewing drugs for the FDA. One of her first assignments there was to review an application for the drug thalidomide as a tranquilizer and painkiller for pregnant women for morning sickness. Even though it had already been approved in Canada and more than 20 European and African countries, she withheld approval for the drug and requested further studies. Despite pressure from thalidomide’s manufacturer, Kelsey persisted in requesting additional information to explain an English study that documented a nervous system side effect.

After  the story received press coverage in July 1962, there was a substantial public outcry. The Kefauver Harris Amendment was passed unanimously by Congress in October 1962 to strengthen drug regulation. Companies were required to demonstrate the efficacy of new drugs, report adverse reactions to the FDA, and request consent from patients participating in clinical studies. Read more about Dr. Kelsey…

Americans Are Drinking Less Soda – and Starting to See Results

There’s no precise way to measure calorie consumption across a general population, but according to several major data sources which track trends in the United States, American calorie consumption is declining.

Barry Popkin, a University of North Carolina professor who has studied food data extensively, described the development as a “turning point.” There is no single moment when American attitudes toward eating changed, but researchers point to a 1999 study as a breakthrough. That year, researchers from the Centers for Disease Control and Prevention published a paper in The Journal of the American Medical Association that turned into something of a blockbuster.

In the intervening years the anti-obesity public health campaigns have focused on one subject more than any other: beverages. This seems to be working. Soda consumption in the US has fallen from an average of 40 gallons per year per American in 1998 to 30 gallons/person/year in 2014.  Interestingly, that 30 gallon average is the same rate of soda consumption in 1980, when the obesity rates started to climb. Though food trends haven’t radically changed — the drop in soda consumption isn’t accompanied by a rise in vegetable consumption, for instance — this is a clear stop in the right direction. Read more… 

Making (Common) Sense out of HIPAA

by Brian L. Grant MD

That HIPAA is misunderstood is an understatement. As this article in The New York Times describes, HIPAA is used as an excuse for absurd interpretations and ultimately a denial of rights to communicate by non-covered entities, a refusal to receive information from family members, churches who erroneously believe they can no longer share the fact that a congregant may be ailing, and other forms of nonsense.

If I had a quarter for every person who made declarative but incorrect statements about HIPAA, it would buy a lot of coffee, and some pastries to boot!

The goal of HIPAA is to maintain the privacy of medical information. But many questions remain. For example, why is unencrypted email apparently unacceptable but a fax is OK, though many senders or recipients of faxes send the faxed documents as Internet attachments? Is an email less secure than the US mail, which could result in a piece of paper lying on a desk in plain sight of the wrong people? I imagine that if the NSA or North Korea has an interest in the files of a medical practice, they may view them with minor effort. But does encrypting email actually solve a problem of files being compromised? The reality is that unencrypted email use is not prohibited. What is prohibited is accessing and reading such information by an individual or more who are not authorized. That raises the theoretical concern that people with time on their hands at Yahoo or Google are opening and viewing emails containing PHI (protected health information).

Protecting medical privacy is important and HIPAA is well-intended and to the degree it compels the profession to establish guidelines, training and evaluating of who and how one shares medical information, it is a good thing. But we have a ways to go to achieve clarity, reduce barriers to good care, and maintain compassion along with common sense.

The Age of Oblivobesity

by Jen Jenkins, Market Analyst, MCN

It’s never a good sign when a health condition prompts new buzz words, in this case “oblivobesity.”  This latest addition to the national discussion on the childhood obesity epidemic introduces this term while shedding some light on the series of (mis)conceptions and (mis)communications that have led to this problem and are continuing to compound it.

Just what is “oblivobesity” referring to? It is a term coined by Dr. David L. Katz, Director of Yale’s Prevention Research Center, to indicate parents’ inability to identify that their children are overweight. A grave review of recent studies published in Childhood Obesity showed some shocking results: Percentages of parents who inappropriately perceived their overweight child as just about the right weight was 96.6% and 94.9% for the [two studies in question]. As high as 78.4% of parents perceived their obese child as just about the right weight in the recent survey. This information helped bring this term to life taking special note of the fact that comparing this 2012 study to a similar study done in 1994 children are not only significantly heavier now but parents are also 30% less likely to notice that there is a problem.

The reasoning behind these revelations spans from the idea that children generally being heavier is considered the “new normal” to, in the words of Dr. Katz, “willful, genuine denial” on the part of the parents. The scary thing is that there is no hope of fixing the issue if the serious health threats that accompany obesity are being ignored or denied. Many different factors come into play when this discussion arises but the important takeaway here is that this growing issue is being swept under the rug in the very place that it must be addressed: American homes.

 

Medicine is a Science, Medicine is an Art

by Jen Jenkins, MCN Market Analyst

An address first delivered in 1926 at Harvard Medical School, The Care of the Patient by Francis W. Peabody, MD explores a topic that seems to remain relevant in the practice of medicine today. Dr. Peabody (1881-1927) was renowned for setting himself apart from his colleagues throughout his career by treating each patient as a real person and not just according to their disease or disorder. The premise of this essay is the belief that “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.” 

As science and technology improved then, and continue to improve now, the practice of medicine puts a greater emphasis on the science and less on the actual care of patients. Students are exiting medical school with excellent knowledge where medicine is concerned but the actual practice of medicine has been somewhat neglected.  Dr. Peabody believed caring for patients is something learned over time, not necessarily in the 4 to 5 years it takes to complete medical school, but he also believed it to be the medical institution’s job to provide the foundation for this type of care. The pressure to effectively diagnose and treat often overlooks the necessity of conversation and the vital importance of creating a personal relationship with the patient. The fundamental sciences will always be imperative but intimately knowing a patient as a human being and not just as a sick individual is the practice of medicine in the broadest sense.

The diagnosis and treatment of disease is a very limited aspect of practicing medicine. A quote that stood out was “The art of medicine and the science of medicine are not antagonistic but supplementary to each other.” Oftentimes, it is not just the disease that needs treating but the individual who needs to be treated. This takes time, which more now than ever is a commodity difficult to obtain in most settings, and it also takes compassion and understanding. The practice of medicine is intensely personal and the more impersonal and clinical the profession becomes the further we stray from the main objective of it all – the actual care of the patient.

See the related 1984 commentary in the Journal of the American Medical Association (JAMA) on this article.

A Changing Landscape: America’s Opiate Epidemic

by Jen Jenkins, MCN Market Analyst

Many Americans have developed an expectation for something that on the surface appears harmless but in reality has proven rather dangerous: the quick fix. This expectation falls into a variety of categories but the dangers here tend to lurk around seemingly magical solutions that directly involve our health.

During the 1990’s there was a surge in pain medication being prescribed freely as an easy fix for chronic pain sufferers over the use of other types of rehabilitation. Prescribers were outspoken about their belief that these drugs were not addicting when used in these scenarios and pain medication was not only being freely prescribed but done so in enormous excess. Between 1999 and 2010 the US saw sales quadruple for opioids such as Percocet, Vicodin and OxyContin. These names probably sound familiar as they have readily become household names, yet we are only more recently being warned about the dangers of using these drugs.

On the other hand, heroin is widely known to be illegal and highly addictive. Fatal heroin overdoses in this country have almost tripled in the past three years, claiming the lives of more than 8,250 people per year. As horrifying as that is, it may not be all that surprising since the dangers of heroin are so well known.  In a shocking comparison, around double that number of people are dying every year from prescription opioid painkillers, which are molecularly similar to heroin. If that statistic is news to anyone it’s probably because overdoses due to prescription medications are far less scrutinized and rarely publicized. The victims of these overdoses are overwhelmingly white, financially well-off, and young; a very different demographic from what we have come to know in relation to other types of drug abuse.

This article in The New York Times provides a snapshot of the new heroin landscape and why it is more dangerous than ever before. Use of this addictive drug had been on decline since the 1980’s but was revitalized thanks to prescription opioid addicts who are more readily turning to heroin as a less expensive and more accessible alternative for a similar high. The article goes on to look at how this change of demographic has also brought about a new kind drug dealer, in particular highlighting the business practices of the group of traffickers dubbed “The Xalisco Boys.”

Although low-profile and anti-violent, The Xalisco Boys are drug dealers to fear because they are going after their customers instead of the old standby of waiting for customers to come to them. They also rely on marketing instead of perpetuating street crime and have devised a system resembling pizza delivery for selling heroin across the United States. Interestingly, they even keep business hours between 7am and 7pm to instill a “safe” sort of atmosphere along with reliable delivery and balloons of heroin that have been properly dosed out by weight and potency. Free samples given out at methadone clinics, discount pricing, and free hits delivered to customers showing signs of quitting are cited all examples of their entrepreneurial take on drug sales.

So what do we do in this ever-changing landscape?  Do we look for resolution on the street or in our clinics and hospitals? Especially now that “street crime is no longer the clearest barometer of our drug problem; corpses are.”

The Problem of Unnecessary, No-Value Care

By Brian L. Grant MD

Atul Gawande, MD once again hits a bull’s eye in this incisive New Yorker article on the massive problem and challenge of unnecessary “no-value” care.

In truth, “no value” is generous, since care with no value removes value from the system by diverting resources from the economy that could be creating value, and by increasing morbidity and occasional mortality that is inherently part of health care but is accepted as part of the risk benefit calculation.

When there is no benefit, one only encounters risk. Gawande cites a 2010 Institute of Medicine Report that 30% of health care spending, or 750 billion per year in the US, is wasted. Spread across the population of patients, this would mean that 30% of the care received offers no value (while carrying risk), and 30% of the care provided by hospitals, doctors, pharmaceutical manufacturers, physical therapists and so on, are wasted. Of course, human nature being what it is, the average patient likely thinks that it is someone else receiving such wasted care and the average health professional may believe, or at least profess publicly, that all which they do or prescribe on behalf of patients is necessary and appropriate.

If we were to accept this 30% statistic and were somehow able to curtail waste without shifting or increasing costs we would not be in the crisis of cost that we find ourselves in. Our 18% or so of GDP spent on health care would be a more moderate, but a still substantial, 12%. By any reasonable standard, Gawande is describing a situation that ought to outrage every citizen. How much of our many other crises could be abated if 750 billion dollars were allocated to them? Education, poverty, social justice, homelessness, child abuse, and neglect? Or for those with more libertarian views, if this money were redistributed to the 319 million Americans for their own spending, we would each by richer by $2,351.00 per year! What would such wealth unleashed on the economy accomplish?

Why does this problem exist? I believe it is a combination of factors including ignorance, greed, and indifference. The ignorance is preventable but is largely driven by the indifference of a consuming population who have little economic motivation to be mindful of what they receive since others are paying the costs via private and public insurance. Greed speaks for itself and takes the form of deliberately doing the unnecessary or a deliberate denial of the potential that a particular intervention is not needed by ignoring the evidence or not asking the right questions. The patient population in the presence of motivation is capable of making informed decisions by asking tough questions of their physicians and doing their own research.

Fortunately, as the article describes, there are systemic alternatives that can lead to change in this pattern of behavior when one is willing to acknowledge and confront the problem.