July 16, 2011

It Is All About The Money for Hospitals

Hit them in the pocket book seems to be the only way the get the attention of Hospitals. This is exactly what the Centers for Medicare and Medicaid Services (CMS) has done and it is having widespread impact. While this needs to be expanded and incentives put in place, it is proving to have an effect and may lead to more actions.

Although I take my shots at the CMS for its euthanasia policies, for once I have to praise them to being on the right path. Those in the medical professions working in hospitals have ignored medically caused infections as just the cost of doing business, when if fact, this is caused by sloppy procedures and carelessness on the part of the people themselves.

Now we need to be concerned about hospital coding procedures and the fraudulent practices of some hospitals. While they say that they are working for coding accuracy, I think this is hospital talk for coding to hide the actual happenings. The survey has one gigantic fault – it did not look at whether the CMS policy actually caused a reduction in infections. The CMS no-payment policy appears to have had a positive impact on hospital infection prevention and control efforts though.

But first, lets use some of the terms for clarity. Infection preventionists is for a medical professional specializing in preventing infections in the hospital settings. This is a recent addition for many hospitals. The next is hospital-acquired conditions (HAC) and this includes much of what is targeted by CMS policy. Healthcare-associated infections (HAI) at present is not targeted by CMS. Catheter-associated urinary tract infections (CAUTIs) is a large concern and catheter-associated bloodstream infections (CLABSIs) bothers me as well.

The Association for Professionals in Infection Control and Epidemiology (APIC) is the professional organization which was conceived in 1972 in recognition of the need for an organized, systematic approach to the "control" of infections acquired as a result of hospitalization. Originally called The Association for Practitioners in Infection Control, the name was changed to the Association for Professionals in Infection Control and Epidemiology, Inc. in 1994 to recognize the organization's maturation and evolution into the broader context of health care delivery in this country. This includes the study of non-infectious adverse outcomes and the movement of care outside the traditional health care system, specifically the hospital. They have even expanded to include activities in prevention of or at least minimizing the effects of Bioterrorism.

In the first paragraph, I mentioned putting incentives in place. This could mean that the hospitals that actually (and not by coding) reduce HACs could receive a bonus for a reduction. I'll leave this to the experts to determine a formula, but this could also help. Would I assess a penalty for an increase in HACs – by all means, even up to losing all CMS monies. Patient safety needs to be a number one priority.

The press release is here for your reading.

July 15, 2011

Some Drugs Sold Without Safety Information

Do you know what to look for when you receive your prescriptions? In the State of Iowa, it is mandatory by law that the pharmacist tell you about your medications especially if they are new to you medications. Plus you have the right to ask about any medication and have them explain the printout if you have questions. Only once have I needed to do this.

For Consumer Reports to find discrepancies in information that lack crucial safety warnings means that some states need to revisit their prescription laws and rules that pharmacists must adhere to and up the penalties for safety violations committed by pharmacists.

The recommendation by Consumer Reports for a nationwide standard, similar to the Nutrition Facts labels on food packages or the Drug Facts labels on over-the-counter medication may be justified. Now, each state pharmacy board sets the rules, the report says. Especially since these findings are so poor when the requirements from the FDA that medication guides are always be included and even this is not happening.

I wish we know which states were included in the investigation, but that is for another day apparently or another report. The chain pharmacies all failed dramatically and you have to wonder when they say that one-third of preventable medication errors occur outside the hospital. I would have thought that this could have been larger, but when you consider that about 1.5 million preventable medication errors occur each year, this is still a staggering number.

According to Lisa Gill, prescription drug editor for Consumer Reports Health, the inconsistencies are difficult for every patient, especially when the font size used for printed material is so small it is often difficult to read. Another problem is all the medical jargon used tends to confuse patients.

The findings are concerning, says Allen J. Vaida, PharmD, executive vice-president of the Institute for Safe Medication Practices, an advocacy group who reviewed the findings for WebMD. He also stated the importance of talking to your pharmacist if the drug is new to you. Another trend by some pharmacies of promising a prescription will be ready in minutes is not a good trend.

Allen J. Vaida, emphasized asking the pharmacist the exact and best times to take a medication. If the directions say twice a day, does that mean at 9 and 3, or is it better to be taken at 9 and 9.

Read the report here. This may help you understand the necessity of getting clear instructions and checking your medications before leaving the pharmacy.

July 14, 2011

Avoid Heat-Related Illnesses This Summer

I hope that you are enjoying your summer, but if you have diabetes, are you taking the precautions necessary to continue enjoying your summer? Some of us have already had some record breaking heat problems and more are expected yet as summer progresses towards fall.

United Health Group's Diabetes Prevention and control Alliance (DPCA) is alerting people and offering some tips to help people with diabetes prevent serious, heat related illnesses. As a person with diabetes, and having had heat stroke as a teenager, I know most of the tips and problems that can happen. Do I need to review these – yes – as each year since developing diabetes, I take time to make sure that I am prepared. You should too!

This reminder from United Health Group is one of the better reminders and as such I urge you to read it. They offer the following seven tips or safety precautions.

1. Be prepared to check your blood glucose levels more often as you change your activity level and know that the heat can affect your body's insulin needs.

2. Please avoid sunburn. Use the sunscreens liberally as sunburn can cause blood glucose level to increase.

3. Drink plenty of water to prevent dehydration. Dehydration adds to the stress and affects your blood glucose levels.

4. Do your best to remain cool and if possible take more breaks – preferably in air conditioned surroundings and if possible exercise in air conditioned areas.

5. Avoid caffeine and alcohol in high temperatures. In addition to raising your blood glucose levels, they can increase the risk of dehydration for people with diabetes.

6. This is IMPORTANT! Keep medication and diabetes supplies as cool as possible, away from direct sunlight, and preferably in a type of cooler. High temperatures and direct sunlight can cause medications and supplies to break down and be less effective.

7. Know the signs of heat exhaustion. If you or someone you know has diabetes and experiences any of the symptoms, seek medical attention immediately. In these circumstances, always place safety first.

The Centers for Disease Control and Prevention lists many of the signs for heat exhaustion - heavy sweating; paleness; muscle cramps; tiredness; weakness; dizziness; headache; nausea or vomiting; and/or fainting.

I have written blogs previously and it would not hurt to review some of them as well.
The first one is here and the second blog refers to many of my prior blogs. Enjoy your
summer safely!

July 13, 2011

ADA Is Now Fear Mongering

When I opened my browser today, like normal my email list shows first.  American Diabetes showed in bold letters. I had to wonder as I don't normally receive emails from the American Diabetes Association. If it is for contributions my spam filter redirects it and I don't even see it. So I thought why not and clicked on it.

In a way, I am glad I did and in another it got my blood pressure one bang of a jolt. Now that I have had time to relax and think about it, it makes sense that since this affects the pocket books of its medical professionals, they would turn to fear mongering. This is a common tactic among politicians to get reelected, but I had not thought a professional medical organization would stoop to such a low-life tactic. Actually, I should have realized that this is just an expansion of the fear tactics they use on their patients all the time.

It is not surprising that when something has the potential to put a dent in the income level or retirement plan of a doctor, the professional organizations will rally to the cause. What rubs me wrong about the tactic of using the ADA is that the organization has little concern for patients or people with diabetes in the first place, but they will ask for our support when their pocket book might take a hit.

Where is the ADA when they are needed for other issues? Oh yes, when there is a public relations opportunity – they will be there. If there is an issue where they can scratch the back of their legal friends – they will be there. If they can somehow be made to look like the good-guy, count on it – they will be there.

Do not expect any support from the ADA when those of us with diabetes just happen to need support to prevent euthanasia because we are going to cost too much money to be keep alive. They will be happy to nail the lid on our coffin.

Where is the ADA when we need test strips for Type 2 diabetes? Yes, they helped the medical insurance companies restrict the number of test strips we may use. So ADA, if you are wondering why you get no sympathy from me, start behaving like professionals and do a few things for patients for a change instead of worrying about your pocket book so much before it happens. Posturing will not get my attention, only my wrath. Both political parties are making with the threats to get support and bring people to their side. It is all posturing for the voters.

What will count in the ballot box in 2012, is the actions taken now, not the fear mongering actions of a medical group. If you feel that way about things, run for political office, then when you use fear mongering, we will know what you mean and how we can vote to chase you out of office. Now we have to live with your threats to instill fear in a community that is tired of this tactic from doctors.  (IDEA*!) That may be a solution, make it an added requirement that they (doctors) must receive so many votes to retain their license on a four year basis.  The use of fear might just disappear - poof!!!  Oh well, it was just a thought.

If you advocated more for patients and their well being over your financial condition, you might receive more support. If we are ever to recover from this financial mess, everyone will need to share the burden – and that includes you – the fear mongering doctors of the American Diabetes Association.

July 12, 2011

Plot Between FDA and Big Pharma Thickens - P2

This press article is somewhat anticlimactic after the previous blog. It is still about Pfizer and the anti-smoking drug Chantix but dated on June 12, 2008. There are some things in the article that I have to question about why ABC News dot com did not check their facts since they had published a story about Chantix.

Quote Now a new report from the nonprofit organization Institute for Safe Medicine Practices cites nearly 1,000 adverse event reports associated with Chantix. That report, released late last month, has prompted the Federal Aviation Administration to ban the drug's use among commercial pilots. Unquote

Now from the June 17, 2008 article – Quote The FAA has prohibited commercial airline pilots from using Chantix because of its possible side effects. Unquote  Yes, the difference of two words “ban” and “prohibit”, but in the world of commercial safety, there is little distinction between the two words. Both indicate that the pilot would be grounded and possibly lose a commercial aviation license for using Chantix.

The biggest plus for the article is that finally shows FDA is doing what it should have back in 2008 when it only warned the Veterans Administration of problems. One does have to wonder how they swept that story under the rug. It does not speak well for the FDA and their review procedures when they can issue a warning to another government agency (that chose to ignore it) and then to ignore the public in the face of mounting evidence. Reminiscent of Avandia anyone?

So this does indeed raise an issue of how much collusion is happening between the FDA and Big Pharma. Are certain interests within the FDA not alerting the public and taking actions at the behest of Big Pharma? With some hesitation, I would have to agree that some evidence certainly indicates that to be happening. I had thought maybe Jo was pushing a little in her blog, but after reading the two articles, I would have to agree with her.

I certainly am more concerned about the safety of many drugs and the side-effects that are not made public until after the elephant has done the damage.

For those that need to read Jo's blog, it is here. For those that did not read the June 17, 2008 article about the abuse of our veterans, it is here and the June 12, 2008 article can be found here.  NOTE:  Jo's blog no longer exists - 10/28/13

July 11, 2011

Plot Between FDA and Big Pharma Thickens - P1

Normally, I leave topics like this for others, but my dander is up and I feel our government is again abusing our veterans and the Federal Food and Drug Administration plus the Veterans Administration is in bed with Big Pharma. This is a combination that I can't in good conscience look the other way on. My thanks go out to another blogger Jo who blogs at joscafe dot com for blogging about this and providing the links. And I don't care that this is not about diabetes.

Since I am also a veteran, I am compelled to write this and am still pulling my thoughts together. I am not even sure how many parts - I am putting this in two parts. First, I will concentrate on the abuse of our veterans and the shame of our government in cooperation with Big Pharma (Pfizer is just one of many and the maker of the drug being exposed) is doing to our veterans. It is a disgrace that our history is such a minefield for our veterans since the end of WWII and probably goes back further than that. Many veterans have been part of cruel medical experiments since then, and the Iraq and Afghanistan conflicts is proving no exception.

Why our Veterans Administration insists on being part of this disgrace is beyond comprehension. Many of our veterans end up in mental institutions because of the experiments they are subjected to and I have to wonder it this is not a part of the increased suicide rate among returning veterans. Even though the article is from June 17, 2008, this and much similar studies are still taking place today.

The ABC News dot go dot com story is properly titled “ 'Disposable Heroes': Veterans Used To Test Suicide-Linked Drugs”. Mentally distressed veterans are being recruited for government tests on pharmaceutical drugs linked to suicide and other violent side effects. One of the human experiments involves the anti-smoking drug Chantix.

Veterans Administration doctors were warned on November 20, 2007, January 18, 2008 and February 1, 2008, by the FDA and Pfizer, but did not issue a warning to the veterans until February 29, 2008.

The following is quoted from the press article to show how little respect the Veterans Administration has for the lives of our veterans. Quote "How this study continued in the face of these difficulties is almost impossible to understand," said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania.

Doctors at the Veterans Administration say they acted as quickly as they could.

"This didn't justify an emergency warning at that level," said Dr. Miles McFall, co-administrator of the VA study.

Dr. McFall said there is no proof that Elliott's breakdown was caused by Chantix and he sees no reason to discontinue the study(1). Some 140 veterans diagnosed with Post Traumatic Stress Disorder continue to receive Chantix as part of a smoking cessation study.

Dr. McFall says the VA decided to continue the Chantix study because "it would be depriving our veterans of an effective method of treatment to help them stop smoking."

Caplan, one of the country's leading medical ethicists, said he was stunned by the VA's decision to continue the Chantix experiment.

"Why take the group most a risk and keep them going? That doesn't make any sense, once you know the risk is there," he said.

Chantix is one of the drugs being used in an estimated 25 clinical studies using veterans by the VA.

Pfizer maintains that "the benefits of Chantix outweigh the risks" and that it continues to do further studies on the drug.

The FAA has prohibited commercial airline pilots from using Chantix because of its possible side effects. Unquote

This is my opinion, but doctors like McFall are the mad people in today's military and need to be convicted for their crimes against our veterans. Please read the full news article for the full impact.
(1)  This is standard military denial.  If you say if often enough and to enough people you can see them actually believing this.  (Agent Orange from Viet Nam Conflict anyone?)