The radiation produced by CT scans performed in 2007 will cause 29,000 cancers and kill 14,500 Americans, according to a study published in the Archives of Internal Medicine. 

To reach this conclusion, Amy Berrington de Gonzalez and colleagues from the National Cancer Institute used a computer simulation to estimate the impact of the 70 million or so CT scans that were performed in the US that year (only 3 million were performed in 1980).

The scientists estimated that about a third of the future cancers will occur in people who were between the ages of 35 and 54 when they received their CT, and 15% of them will develop in people who were children or teens when the scan was performed.

About two-thirds of the new cancers will develop in women, since they are more vulnerable to radiation.

“There is a significant amount of radiation with these CT scans, more than what we thought, and there is a significant number of cancers,” Rita Redberg, the editor of the Archives of Internal Medicine, told the LA Times.

“While certainly some of the scans are incredibly important and life saving, it is also certain that some of them were not necessary,” Redberg added.

CT scans provide pristine images by combining data from multiple x-ray images. They can also expose patients to up to 400 times more DNA-damaging radiation than conventional chest x-rays. 

In another study, Rebecca Smith-Bindman and colleagues from UCSF found that radiation exposure varies almost 13-fold for different kinds of CT studies, from about 2 millisieverts for a routine head CT scan to 31 millisieverts for a scan of the abdomen and pelvis.

The average American receives about 3 millisieverts of radiation per year, a level not considered to be a health risk.

Inappropriate use of antibiotics and consequent antibiotic-resistant infections waste $20 billion per year, according to a study published in Clinical Infectious Diseases.

To reach this conclusion, Rebecca Roberts and colleagues at Cook County (Stroger) Hospital quantified antibiotic resistant infections (ARIs), total costs, length of stay, length of ICU stay, surgeries and mortality rates for 1,391 high-risk adult patients that were hospitalized in the year 2000. 

The scientists found that 188 (13.5%) patients developed an ARI. The medical costs attributable to ARIs ranged from $18,588 to $29,069 per patient. In these patients, length of stay was 6.4–12.7 days longer than in those who did not develop ARIs. Excess mortality in the ARI group was 6.5%.

Common ARIs include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), as well as many other bacteria that are becoming resistant to common antibiotics.

“Significant health and economic benefits could be realized through effective interventions to reduce antimicrobial-resistant and healthcare-associated infections,” said Roberts in a press release.

Stuart Levy, a senior author on the paper added that his study “demonstrates the enormous cost savings that could be realized for both the health care system and to individuals and their families…these costs will continue to increase if we don’t practice a more prudent usage of antibiotics.”

Levy added that more studies are needed to determine how much could be saved at a national level if we took steps to slow the rise of resistant infections, especially those acquired in hospital settings.

Many believe that healthy people should examine themselves regularly or submit to cancer screening because early detection saves lives.

That’s likely true for women, who should begin cervical cancer (Pap) screening by the age of 21, and for adults 50 years or older, who should get colonoscopy.

And it’s probably true for women at least 40 years old, for whom many suggest it’s wise to get mammograms annually to screen for breast cancer.

But that’s about it, at least according to today’s best evidence.

Which brings us to a well-meaning but ultimately dangerous PR campaign by the Light of Life Foundation to raise awareness about thyroid cancer.

“Confidence kills. Thyroid cancer doesn’t care how healthy you are,” read ads in People magazine, Sports Illustrated and elsewhere.  “Ask your doctor to check your neck.”

Thyroid cancer kills about 1,600 Americans per year. In other words, it’s responsible for about 0.3% of all cancer deaths in this country.

And there’s not a shred of evidence that routine neck exams cut the risk of death from thyroid cancer, according to Barnett Kramer, an associate director for disease prevention at NIH.

Most thyroid cancers grow slowly and are curable surgically no matter when they’re found, and the remaining ones are so aggressive that early detection doesn’t’ improve outcomes anyway, according to Kramer. 

A routine thyroid screening program would trigger thousands of unnecessary ultrasounds and needle biopsies not to mention thyroidectomies that risk damaging the vocal cords.

And there’s no guarantee that cursory palpations of the gland by busy PCPs would detect more than a small percentage of the tumors anyway.

Healthy people should consult with their physicians about cancer screening. And they should contact their physicians if new symptoms develop or if their health status changes in any way.

For a science project, Morgan DiSanto-Ranney, a 16 year-old Virginia high school student recently purchased 7 glucose monitors and asked her diabetic father to use them all.

“What I found was that the meters were off from one another by 60 to 75 points,” she told the New York Times.

About the same time, government researchers found that the results from 5 widely-used monitors varied by up to 32%.

Inaccuracies like this expose patients to seizures, loss of consciousness and rarely, death, so the American Association of Clinical Endocrinologists asked the FDA to act on the matter.

“Because of the highly variable quality of the meters and the glucose testing strips in widespread use, the safety of our patients who depend upon those meters is threatened,” it wrote in a letter obtained by the New York Times.

Nothing happened immediately but as it turned out, Morgan’s mother works for Iowa Republican Senator Charles Grassley, and before long the Iowa Republican had fired off a letter asking the FDA to investigate.

The FDA had for decades punted glucose QA responsibilities to the International Organization for Standardization, whose regulations permit the devices to be off by up to 20%.

Upon receipt of Grassley’s love letter, the FDA began pressing the IOS to tighten its standards, and warned that if it refused to do so, the FDA “may instead promulgate other (higher) performance standards” on its own.

As the matter simmers, glucose monitor manufacturers have warned that more stringent accuracy requirements would force them to jack up prices which would, in turn, discourage their use.

For his part, Morgan’s father has lost faith in his glucose monitors. “He doesn’t use them as much anymore,” sighed the high school student.

Readmissions to hospitals, defined as a second admission within 30 days of hospital discharge for the same or a similar medical condition, cost Medicare $17 billion per year.

Many readmissions can be prevented by coordinating post-discharge care more effectively and implementing simple home monitoring programs.

The problem is that when hospitals implement such programs, it sets them back financially. Payers like Medicare reap all the benefits. 

Take Park Nicollet Health Services, for example. The Minnesota-based hospital and clinic system has long-since established a reputation for its innovations in the quality of care. Four years ago, the provider began spending $750,000 per annum on nurses and special software to reduce readmissions for congestive heart failure.

The program reduced such readmissions from 16% to 4%.

The program saved Medicare $5 million per year, but Park Nicollet received not a cent for its efforts. In fact, fewer admissions for the condition actually cut revenues for the intrepid quality leader.

“We’ve kept it up out of a sense of moral obligation to these patients, but we’re getting killed,” Park Nicollet’s chief executive David Wessner told the New York Times.

“We have a reimbursement system for health care that is not aligned with providing high-quality care,” said Barry Straube, Medicare’s CMO. “Unequivocally, there has to be payment reform.”

Michael Connelly, chief executive of Catholic Healthcare, which has similar programs, says payers need to bundle payments for a hospital stay and the follow-up care.

“One of my frustrations is it’s taking so long to do this,” he told the Times. 

“Hospitals who say they are penalized for doing the right thing are right,” concurred Robert Berenson, a policy analyst at the Urban Institute. “If we can’t do this, we can’t do much of anything in health reform.”

Harvard scientists have found that as people age to a point where they become eligible for Medicare, the improved access to care it assures is associated with reductions in racial and socioeconomic disparities in health status.

That supports a contention made by many that universal coverage could narrow the US’ appalling gaps in the quality and outcomes of care for non-whites and the poor.
 
Before reaching these conclusions, John Ayanian and colleagues performed observational and quasi-experimental analyses of cross-sectional data from the National Health and Nutrition Examination Survey. Data had been collected between 1999 and 2006 from adults aged 40 to 85 years old.
 
The scientists found that measures of disease control improved significantly across all racial and socioeconomic subsets during the 7-year study period, which had the effect of preserving racial disparities noted at study onset…until that is, people reached an age where they qualified for Medicare.

That’s when the gaps narrowed dramatically.

Once people with hypertension enrolled in Medicare, Black vs. white disparities in systolic blood pressure dropped by 4.2 mm Hg, a 60% reduction.

Similarly, Medicare enrollment was associated with a 70% reduction in Black-white disparities for hemoglobin A1c levels, a measure of diabetes control. There were similar reductions in disparities when people were stratified according to educational status. 

“Universal health insurance may reduce persistent disparities we’ve seen for far too long in Americans from different racial or ethnic groups,” Ayanian told BurrillReport. He’s a professor of medicine and health care policy at Harvard Medical School and Brigham and Women’s Hospital.
 
The write-up is in the Annals of Internal Medicine.

“The results of this study make it clear that guaranteeing access to affordable insurance for all Americans is the essential first step toward…a healthier America,” said Karen Davis, president of the Commonwealth Fund, which funded the study.

Everyone agrees that controlling health care cost escalation is vital to cutting our budget deficit.

The problem is that no one agrees how to do it, and yesterday’s kumbayah press release by key stakeholders certainly hasn’t addressed the issue substantively.

The Big O has already ticked-off Big Insurance by cutting payments to Medicare Advantage plans, and the $1.1 billion he tucked into his Economic Hail Mary for comparative effectiveness research has garnered similarly negative reviews from Big Pharma and the Device Makers.

Obama believes cost-effectiveness research can help physicians reduce wasteful or ineffective treatments, especially if they are reminded about the findings at time they write orders.

This could be done by incorporating reminder systems into those newfangled EMRs he’s incentivizing physicians to adopt.

The Hail Mary allocated $400 million to the National Institutes of Health, $300 million to the Agency for Healthcare Research and Quality, and another $400 million to Health and Human Services.

This amounts to a budget increase, not a policy shift for AHRQ. For example, its 2007 guide to pain medication for osteoarthritis explained how a 30-day supply of Lodine cost $170 whereas the same course of treatment with aspirin cost $10.

And CMS has long-since established the precedent of using AHRQ-sponsored research in reaching coverage decisions for Medicare and Medicaid.

Still, the decision raised red flags for Big Pharma, whose trade group was one of the signees in yesterday’s kumbaya press release, and the device makers as well.

Teresa Lee, a VP at the Advanced Medical Technology Association, warned the Wall Street Journal for example that using “this research to deny access to appropriate treatments for patients with (specific) medical histories and needs should not be the objective.”

And on the Hill, Republican Senator Jon Kyl just missed passing legislation that would have prevented CMS from relying on comparative effectiveness research to deny coverage.

Charles Grassley and Russ Feingold, 2 key actors in health reform legislation, voted for that one.

Outcomes data can be confounded by patient factors like burden of illness, and they are time consuming and expensive to collect.

That’s why many quality measurement programs focus on process quality and cross their fingers that the link between process and outcomes actually holds true.

Uh, guys…can we huddle up a minute?

Leslie Kernisan and colleagues at UCSF just finished a study to determine whether performance on a set of process measures known as Safe Practices for Better Healthcare could predict hospital mortality.

They couldn’t.

Hospitals with higher scores on the Safe Practices indices did not have lower inpatient mortality than those with lower scores. Progressing from the worst to the best quartile on Safe Practices, inpatient death rates bounced around from 1.97% to 2.04%, to 1.96% to 2.00%.

Data from more than 1,000 hospitals were analyzed. These data were adjusted for patient and hospital variables that could impact the results.

“It is possible that inviting hospitals to self-report on their patient safety practices and then assigning them to quartiles of score is not an effective way to assess hospital quality and safety,” stated the authors.

That may be, but it’s more likely that inpatient mortality rates are not sensitive enough as measures of quality. Before throwing in the towel on these process measures, scientists would be wise to see how well they predict other, more sensitive outcome measures like readmission rates, functional status at discharge and 6 months, and so forth.

Then again, they could be lousy process measures, or the data collection tools could have been flawed.

The Safe Practice Guidelines have been endorsed by the National Quality Forum. The write-up appears in JAMA.

Eight months after an astute cardiologist discovered a potentially life-threatening problem involving cables that connected Medtronic’s Sprint Fidelis defibrillator to the heart, the medical device giant pulled the product off the market.

By that time, five people had died and the toxic asset had been deposited into the bodies of 250,000 patients where they remain to this day.

Physicians are left to decide on a case-by-case basis whether to ride out the storm or risk a dangerous procedure to remove the cables.

The cables tend to crack causing the charge-box to either deliver shocks at inopportune times or fail to discharge at the moment of truth. Medtronic estimates a 5% cable failure rate at 45 months after implantation.

Cable extraction is dangerous because they end up becoming encased by fibrous overgrowth in the veins draining directly into the heart. The tricky dissection has already been associated with 4 deaths due to hemorrhage.

“We are just seeing the tip of the iceberg,” Ohio State University cardiologist Charles Love told the New York Times.

The procedure is best performed by cardiologists skilled in such removals, but such experts are harder to find than a PCP in Boston.

Medtronic has so far been protected from lawsuits by a Supreme Court decision involving another device in which it was decided that device makers can’t be held liable for products that have been approved by the FDA, a decision that seems inconsistent with its findings in Wyeth v. Levine. 

Medtronic’s position is that the cables should be replaced only as a last resort. It covers the costs of replacement cables, but not the procedure which typically runs a cool 15 grand.

Michigan State University scientists have found that brand name information and marketing claims overshadow fine print safety warnings on OTC medications, despite Federal regulations requiring that display of the latter should be “prominent” and “conspicuous.” 
 
Laura Bix and colleagues used an eye-tracking device to quantify the visual inspection patterns of subjects as they scanned package labels on OTC pain killers and subsequently assessed the extent to which subjects could recall the information.

The scientists focused on five elements of the package label: brand name, the statement of claims such as “extra strength,” drug facts information, the child-resistant warning and the tamper-evident warning.
 
They observed that subjects focused primarily on the brand name and much less on the 2 warnings.  For example, 67% of the subjects were able to remember one or more brands they had observed during the study, but only 18% recalled alcohol-related warnings.

A dismal 8% remembered the warning that the product shouldn’t be used in homes where young children were around and not one single participant recalled the warning about tamper-evident features.
 
Part of the explanation, according to Bix and Co., is that the brand and product claims were more legible than the warning statements.

Their write-up appears in Proceedings of the National Academies of Science.

“To be effective, warnings about the lack of a child-resistant feature, or those that alert consumers to potential tampering of the product, need to be read and comprehended at the time of purchase,” Bix told BurrillReport.

“Little guidance exists from the federal government regarding what it means to be ‘prominent’ or ‘conspicuous,’ yet, this term is used quite frequently in the regulations that dictate labeling for a variety of product,” Bix added.

Massachusetts General Hospital can’t seem to get out of its own way lately.

Already in the doghouse with Bay state public health officials for high mortality rates in its cardiac cath program, the prestigious Harvard Medical School affiliate has suspended its pediatric cardiac surgery program after errors during 2 open-heart surgery procedures caused serious complications.

The public health officials, who have to be considering monthly parking permits in the lot on Fruit Street as a way to control costs, began looking into the incidents shortly after the General notified them last week.

Both babies survived the mishaps, although one sustained neurological damage and required transfer to Children’s Hospital across town.

Just 2 years ago, the General beefed up what had been a tiny pediatric cardiac surgery program by recruiting Jeff Myers, a specialist in the field.

The unfortunate development has reignited debate concerning the extent to which patient outcomes are compromised by policies, or the absence of same, that foster proliferation of multiple low-volume providers for complex, risky procedures like this one.

Children’s Hospital is located just 4 miles west of the General. It does 1,100 pediatric open-heart cases per year, making it the highest-volume program in the country.

The General has managed to log 90 cases in the last 20 months. Meanwhile, about 3 miles south of the General, Tufts Medical Center has a program that did 24 last year.

The General’s “numbers are pretty small” Peter Manning told the Boston Globe. The director of CT surgery at Cincinnati Children’s Hospital added, “when you get below 100 cases you really worry… whether the [surgeon] is doing enough to keep their skills up.”

With apologies to GE, Disney and the 8 US citizens who remain optimistic about prospects for our health care system.

Welcome to the US Health Care Carousel of Progress!

Normal carousels just spin ’round and ’round and don’t get you anywhere, but ours is different.

The Health Care Carousel makes progress every year.

And progress isn’t simply moving forward, it’s working together and dreaming and assuring better health care for all.

Progress is the whiz-BANG of an MRI machine in use for the evaluation of a 22 year old with a headache. It’s the drug-induced smile on the face of a woman that became depressed after losing her home to foreclosure.

Progress is the rhythmic lub-dupp of a heart beating normally following a transplant for preventable cardiac disease. It’s the sound of an uninsured child wheezing in a crowded emergency room.

Why, you can hardly imagine all the amazing gadgets they’ve got in ERs nowadays!

Remember the sixties when folks got their exercise doing the Twist? Well, today we keep our cholesterol down with pills!

And our food safety system has never been better.

Our generation may be the first in 300 years to experience a decrease in life expectancy, but think how much worse it would be without $10,000 cancer drugs and blood thinners that prevent complications from hardware we’ve inserted into people’s bodies.

It’s never been easier to find a PCP, and would you believe it? They’re building our city’s 17th PET scanner right where that run-down urban health clinic used to be.

You should hear physicians rave about how those newfangled EMRs save them time.

And progress even has a smell! It’s the smell of money lining the pockets of a hundred-thousand physicians that have been bought off by Big Pharma.

With all these marvels, it’s hard to believe things could get better than they are right now. But as you join us for a spin around our Carousel of Progress, you’ll surely agree. Anything’s possible.

Ethics
In a referenced essay titled, Transparency in the Pharmaceutical Industry, Brain Blogger’s Jennifer Gibson describes how the impending passage of the Physician Payments Sunshine Act has motivated Big Pharma to disclose financial relationships with physicians. She warns there may be adverse consequences from this otherwise laudable development: some physicians will be discouraged from forging socially beneficial collaborations with the private sector.

Last week, the FDA’s Psychopharmacologic Drug Advisory Committee unanimously rejected AstraZeneca’s application to market its atypical anti-psychotic drug Seroquel for generalized anxiety disorder and major depression.

Merrill Goozner at GoozNews applauds the decision, but wonders whether the agency may have left itself open to charges of bias by seating a patient representative on the panel who had lost a son to cardiac arrest while taking the drug. 

Health Care Renewal contributor Roy Poses has reviewed an unseemly side show to the Madoff scandal. The antagonist is Ezra Merkin, a hedge fund director charged with fraud for misrepresenting his investment strategies.

Merkin and Madoff had served on the board of Yeshiva University, which lost $110 million to the Ponzi scheme. Their unholy alliance leads Poses to consider possible negative consequences of having too many financial types on the boards of academic institutions.

Insurance
In the latest chapter of her neverending odyssey to navigate Big Insurance and the health care system generally, Colorado Health Insurance Insider’s Louise Norris describes what happened when her husband needed knee surgery. The savvy couple planned for every contingency, yet still they encountered a system failure in the form of an out of network charge.

Jaan Sidorov at Disease Management Care Blog has proposed a frightening, unintended consequence of health care reform which is that private health insurers might, like AIG, become too big to fail.

Sidorov thinks creation of a new public insurer will prompt a wave of consolidation in Big Insurance, and the remaining behemoths will seek cover in the form of regulatory oversight from the Feds.

Over at The Health Care Blog, Brian Klepper has contributed a wide-ranging historical perspective on efforts by Big Insurance to control health care cost escalation.

After characterizing utilization review and PCP gatekeeper systems as well-intentioned but poorly executed efforts, he proposes that tricked-out workplace-based clinics (“onsite clinics”) may be a solution, and cites facilities on the premises of Cigna as shining examples.

He concludes however, that the proof will be in the pudding. After all, everyone thought UR and gatekeepers were good ideas, too.

There’s a great, big, beautiful tomorrow,
Shining at the end of every day

There’s a great, big, beautiful tomorrow
And tomorrow’s just a dream away

Man has a dream and that’s the start
He follows his dream with mind and heart

When it becomes a reality
It’s a dream come true for you and me

Access, Cost Escalation
InsureBlog’s Bob Vineyard reviews interim results from Massachusetts’ much publicized universal health care plan, which many believe should be a model for national health care reform.  The plan has left at least 200,000 state residents uninsured while utterly failing to rein in costs. And to make it right Vineyard warns, Bay state lawmakers are either going to have to squeeze providers even more or (gasp!) ration care.

At Managed Care Matters, Joe Paduda has posted a dispassionate, fact-based treatise designed to calm the knee-jerk anxiety that normally surrounds concepts like universal health care and rationing.

He points out for example that Big Insurance already engages in rationing through pre-certification processes, provider agreements and so forth.

He then dismantles the claim that universal health care leads to longer waiting times for care. Paduda concludes that if we manage to institute such programs, “access will go up and waiting times may well go down.”

Amid a fusillade of jabs and an occasional uppercut to the jaws of the Big O and his admirers, JD Bell reveals over at It Takes Work that Howard Dean has launched a web site to promote his own vision for health care reform.

According to Bell, Dean is concerned the Big O is waffling on his campaign promises, and wants nothing more for the American people than what Obama promised them prior to November 4.

Writing for Workers’ Comp Insider, Jon Coppelmen observes that employers’ most effective tools for managing comp losses vanish after they lay off employees. The trust, indeed the entire relationship between employer and former employee, is lost. This leaves claims adjusters, who are typically overworked and not properly incented, to manage workers’ compensation costs.

With unemployment approaching historical levels, Copplemen’s antidote, three proactive steps employers can take to manage the regrettable situation, is timely indeed.

Quality and Safety
A recent NEJM article on the cost and quality implications of readmissions has prompted Maggie Mahar to review the subject over at Health Beat. Mahar summarizes the views of White House budget director Peter Orszag and others on the matter, and then offers several home-grown suggestions about how to tackle the problem.

Mahar explores for example, the concept of bundling payments to hospitals and physicians who are responsible for care immediately following discharge, and directing special attention towards states in which the readmission problem is particularly severe.

Novo Nordisk had been prepared to discuss cardiovascular complications at last week’s FDA advisory panel meeting regarding liraglutide, its new diabetes drug, but instead the drug’s association with rare tumors of the thyroid drove the discussion.

Jeffrey Seguritan at Nuts for Healthcare summarizes the surprising development then expands into an informative discussion of the efficacy with which drug trials assess cancer risk.

There’s a great, big, beautiful tomorrow,
Shining at the end of every day

There’s a great, big, beautiful tomorrow
And tomorrow’s just a dream away

Man has a dream and that’s the start
He follows his dream with mind and heart

When it becomes a reality
It’s a dream come true for you and me

Legal
HealthBlawg’s David Harlow is generally supportive of the deal struck by CVS and Google, in which prescription data from the retail pharmacy giant can now be directly imported into Google Health, the search giant’s personal health record. On balance Harlow says, the gains in patient safety and quality outweigh the increased risk of breaches in patient confidentiality, at least for people who have not recently given birth to octuplets or are named Britney Spears.

Health IT
When a healthcare journalist came down with a touch of bronchitis, he blew off the last vendor meeting at HIMSS and went to the doctor.

His encounter underscored a yawning gap between today’s reality of spotty EMR adoption and a future-state of nirvana that has been promised by so many. 

The real-life story appears at Niel Versel’s Healthcare IT Blog.

We hope Neil feels better, by the way.

At the Health Business Blog, David Williams has posted a transcript of his interview with Wayne Guerra, the co-founder and chief medical officer of Healthagen, the maker of a way-cool iPhone application known as iTriage.

In the interview, Guerra explains how his mobile triage and health information tool can be used, the types of people most likely to benefit from it, and how he hopes to monetize the idea.

The Healthcare IT Guy invited Paul Nuschke, a software design expert at the IT consultancy Electronic Link to comment on the subject of EMR usability. Nuschke asserts there are three keys: the EMR should be easy to learn, efficient, and prevent errors automatically.

Nuschke appends a series of baffling screen shots which make it laughably clear that some of the mainstream players in the space aren’t quite there yet.

Policy
Over at the Healthcare Economist, Jason Shafrin asks, “Why have disability rates decreased?” To answer the question, Shafrin reviews a scholarly piece from the National Bureau of Economic Research. He notes that the apparently heartening trend has occurred despite an increasing burden of illness in the general population. The beneficial trends, he concludes, are attributable primarily to non-medical advances like “internet shopping, amplifying devices for phones and street ramps” rather than health care-specific interventions.

Damn, we thought we had something there for a moment.

Actual US Health Care Carousel of Progress:

Three years ago when Merck introduced Gardasil, the anti-HPV vaccine for the prevention of cervical cancer and genital warts in girls, the buzz focused on whether it might encourage girls to have sex.

Now, the vaccine maker wants to market the jab for boys and the tweets are all about vaccine safety and cost-effectiveness.

That seems fair.

Human papillomavirus causes cervical cancer, which strikes 10,000 and kills 3,700 US females per year. In males, HPV causes 7,500 cancers per year, involving primarily the penis and anus, and kills about 1,000. 

Gregory Zimet, a Indiana University professor of pediatrics marveled the hypocrisy. “I wonder if it was the reverse, and there was a vaccine for women that helped prevent prostate cancer in men, this would be as much of an issue.”

After the FDA green-lighted Gardasil in 2006 for girls aged 9 and up, medical groups recommended they should take the spike by age 12, or before they became sexually active.

At the time Merck tried to persuade states to add Gardasil to the list of vaccines required for children to attend school. It dumped that strategy after being scorched by critics who thought the decision should be left with parents.

Merck’s field tests of Gardasil in men show that it is safe in the short term, and that it prevents HPV infection, genital warts and precancerous growths.

Gardasil vaccination costs about $500 for the 3 shots and the related office visits.

Part of the Big O’s plans to improve clinical effectiveness involves setting up registries to monitor patient outcomes after interventions like chemotherapy or the insertion of a medical device.

Come to think of it, that’s how Robert Hauser first detected problems with Medtronic’s mission-critical heart defibrillator a few years back.

Using data from a small registry at the Minneapolis Heart Institute, Hauser deduced that cables connecting the Sprint Fidelis defibrillator to the heart tended to crack causing the charge-box to either deliver shocks at inopportune times or fail to discharge at the moment of truth. 

In early 2007, Hauser raised the matter with Medtronic, which recalled the product 8 months later. The company indicated at the time that 5 deaths may have resulted from the problem.

Last week, Hauser and a colleague published another registry-based study suggesting the problem was worsening for patients who still have the hardware in their chests, and that physicians should consider replacing the cables proactively.

Medtronic disputes the findings, claiming its own analysis is based on a much larger sample and the ruckus is likely to continue for the foreseeable future.

A properly funded, well-designed national registry would settle the matter in a heartbeat, not to mention detecting the problem more quickly than Hauser was able to manage, according to cardiologist Alan Kadish of Northwestern.

Funny thing though, in 2004 Medicare required formation of a defibrillator registry as a condition for approving the devices for use in a new class of patients in whom only equivocal evidence suggested they were helpful.

But Medicare never put a dime towards funding it and support from the device companies tailed off after the first year.

Now, hospitals pay for a stripped-down version of the registry and get marginally useful benchmarking data in return.

The mini-registry can’t merge its data with Medicare claims, meaning among other things it can’t track longer term outcomes, which is pretty much the whole point.

A new survey by the UK-based Beat shows that only 15% of patients with eating disorders such as anorexia and bulimia felt their GP understood their condition or knew how to help them.

Some said they felt their primary care physician did not take their problems seriously. Others felt they lacked knowledge about treatment options.

In England, the number of girls and young women requiring hospitalization for anorexia has increased 80% in the last decade. More than 1.1 million people in the UK are believed to have an eating disorder.

“People affected by eating disorders still aren’t getting the treatment and support they need,” Beat chief executive Susan Ringwood concluded.

According to the BBC, one young person in the survey was told to “go home and eat a burger,” while another was reassured she was just going through “a phase.”

Recently British Prime Minister Gordon Brown said the NHS needed to improve diagnostic and therapeutic performance on eating disorders. “Sometimes it is late and sometimes things have gone too far,” he said.

But Steve Field, chairman of the Royal College of GPs said physicians are for the most part doing an excellent job.

“It’s not very often that the patient comes to the GP and says ‘I’ve got an eating disorder’, but doctors do know what they are doing and the signs to look out for and patients should be reassured of this” he said.

Beat is the UK’s leading charity for people with eating disorders. It provides help lines, online support and self-help groups.

NICE guidelines on eating disorders state that recovery is possible provided GPs listen to their patients, act quickly and, in the case of young people, involve their families as much as possible.

Fifteen percent of all hospitalized patients experience at least one adverse drug reaction during their stay, and each ADR adds about 0.25 days onto the length of stay, according to Munir Pirmohamed and colleagues at the University of Liverpool.

To reach this conclusion, the scientists tracked the hospital stays of 3,695 consecutive patients admitted to 12 hospital wards during a 6-month stretch in 2005.

They reviewed charts to assess causality, severity and preventability, and performed multivariate analysis to identify ADR risk factors.

In all, 545 patients experienced at least one ADR. The report is in Plos One. 
 
The most common ADRs included bleeding, constipation, confusion, renal problems, and nosocomial infections involving Clostridia, Staph and other potentially life-threatening bacteria.  Half of all ADRs were felt to be definitely or possibly preventable.

The most commonly offending drugs were narcotic analgesics, anticoagulants and diuretics.
 
The number of drugs being taken by a patient turned out to be the most significant predictor of ADRs, with each additional medication multiplying the risk by about 14%.

Elderly people, who tend to be taking many medications, were therefore found to be at high risk for ADRs.
 
“Our results show that the overall burden of ADRs on hospitals is high and therefore new methods of intervention are needed to reduce this,” Pirmohamed told BurrillReports. 
 
“We are currently looking at…ways of improving the safety of medicines, including increased monitoring…and identification of genetic factors that increase the risk of…adverse effects,” he added.

Other groups, particularly Boston’s Institute for Healthcare Improvement have made progress in this area. Even so, IHI estimates there are as many as 15 million incidents of medical harm each year in US hospitals.