Hospital closures: “Survival of the fattest”

No. Grove St. Today. Note street sign.

MGH

Some say the health care system could stand to shrink a bit. Here, Alan Sager of BU uses the sudden closure of North Adams Regional Hospital to argue that the wrong hospitals are closing.  Hidden on the Globe letters page:

Over half of the Massachusetts hospitals open when John F. Kennedy was elected president have now closed. Not one that closed was a major teaching hospital. Heavy reliance on teaching hospitals helps explain our state’s extraordinarily high hospital costs. The pattern of closings may be partly responsible for that reliance.

Some might suppose that a functioning free market protects needed and well-run hospitals while closing unneeded and inefficient ones. Sadly, that pattern seldom prevails. Low-cost, efficient hospitals are not likelier to survive. But hospitals in wealthier places, with more patients insured by higher-paying insurers, rarely close. Some call this survival of the fattest.

More good work from the Globe health desk here:

 Are cardiologists refusing to follow new cholesterol recommendations?

#Google #Glasses in the hospital: A “mixture of intrigue and skepticism. #HIT #EMR

google glasses

Giuseppe Costantino photo

When it comes to health information technology — a term that encompasses everything from medical records to monitors — John Halamka – the chief information officer at  of Beth Israel Deaconess Medical Center — is the man. Here he reports on wearable computing in the hospital.

Here’s what we’ve learned thus far:
 
halamkaPatients have been intrigued by Google Glass, but no one has expressed a concern about them. Boston is home to many techies and a few patients asked detailed questions about the technology. The bright orange pair of Glass we have been testing is as subtle as a neon hunter’s vest, so it was hard to miss.
 
Staff members have definitely noticed them and responded with a mixture of intrigue and skepticism. Those who tried them on briefly did seem impressed. More from Halamka on his own blog Life as a Healthcare CIO.
Photo permissions:
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Globe: BU sports #concussion doc plays for both teams

Today’s Globe has a terrific story on conflicts of interest for BU’s Dr. Robert C. Cantu, the go-to expert on  football concussions.

The story is behind the pay wall, but click here for a great interactive graphicglobe ss

He is America’s concussion doctor, a pioneer in the fight against sports-related brain damage. …

Yet for all his contributions, Cantu’s roots in the field have grown so tangled that his connections with parties on many sides of the concussion crisis have become emblematic of the conflicting interests in the football, helmet, medical, and scientific communities.

Cantu has worked for and against the NFL. He has been paid to help set helmet safety standards for the National Collegiate Athletic Association while accepting tens of thousands of dollars to submit testimony for players suing the NCAA over head injuries. And corporations that Cantu has served or promoted have contributed more than $1.3 million to entities he helped to create, including a research center, concussion foundation, and charitable endowment.

(Disclosure: TR teaches at BU.)

NEJM: 80% of arthroscopic partial meniscectomy procedures do little for the knees

Note: Consider BMC for your next knee surgery. You may not need it.

From The New York Times:

A popular surgical procedure worked no better than fake operations in helping people with one type of common knee problem, suggesting that thousands of people may be undergoing unnecessary surgery, a new study in The New England Journal of Medicine reports.

The Finnish study does not indicate that surgery never helps; there is consensus that it should be performed in some circumstances, especially for younger patients and for tears from acute sports injuries. But about 80 percent of tears develop from wear and aging, and some researchers believe surgery in those cases should be significantly limited.

“Those who do research have been gradually showing that this popular operation is not of very much value,” said Dr. David Felson, a professor of medicine and epidemiology at Boston University. This study “provides information beautifully about whether the surgery that the orthopedist thinks he or she is doing is accomplishing anything. I think often the answer is no.”

Globe: BWH surgeon sues BWH over wife’s post-#hysterectomy #cancer diagnosis

The Globe’s play on this story should say something — Metro front rather than 1A.  Malpractice stories are tricky– serious charges and a response penned by a lawyer, not a doctor.  (At 8 a.m., a complete version of the story was lingering on White Coat Notes, outside the paywall.)

Note the Brigham’s carefully worded statement on the link between cancer and  morcellation, the procedure used during a minimally invasive hysterectomy.

The Brigham said in a statement that “while it’s not possible to know what impact the procedure will ultimately have on Dr. Reed’s health, we do know that literature suggests morcellation of malignant tumors increases the chances of mortality. 

Here’s the lead

A Boston surgeon and his wife, an anesthesiologist, are pushing to stop a widespread surgical technique used on thousands of women during hysterectomies, which they say caused her undetected cancer to dangerously spread.

The she said/she said suggest that

Dr. Barbara Goff  president of the Society of Gynecologic Oncology and director of the Division of Gynecologic Oncology at the University of Washington in Seattle says “Morcellation allows many women to have safer hysterectomies with better outcomes than full abdominal surgery, including less blood loss, smaller wounds, and a quicker overall recovery.”

“You try to balance cost and outcomes and doing the best you can for an entire population of women,” Goff said.

But Dr. Bobbie Gostout, chairwoman of obstetrics and gynecology at the Mayo Clinic, said more women should be given the option of a vaginal hysterectomy, where the uterus can often be taken out intact through the vagina, especially because morcellation “is a questionable practice.”

She said morcellating devices are not yet good at capturing tissue or protecting other sensitive organs from rotating blades.

“I don’t want to see [morcellation] go away, but I would like to see it kept in perspective and occupy its necessary place,” she said. “Morcellation is still so far off what it ought to be.”

HIV, gone after marrow transplant, returns to Boston’s “Berlin” patients

Update: Health News Review used this story as an example of overuse of the term “cure.” HNR also pointed out how the “cure” got a lot of coverage and the news that it wasn’t a cure did not.

The Globe’s story is behind the paywall. Here is the nut.

Or here

Boston researchers are reporting the return of the HIV virus in two patients who had become virus-free after undergoing bone marrow transplants, dashing hopes of a possible cure that had generated widespread excitement

The story reports that doctors detected the return of the virus in one patient in August. The second patient chose to continue in the study, but in November, doctors found traces of HIV and he went back on his medication

Some background here from Nature Boston. 

More on the meeting where this was reported here.

As pointed out above in HNR, the overuse of the term “cure” often leads to disappointment? Here’s what the Google search looks like:

ssniOr here.

Obesity surgeon — with support from colleagues — kept practicing despite complaints, via Boston Globe

randallAnother reason to subscribe to the Globe: This Sunday story about how hard it is to get the knives out of the hands of potentially dangerous surgeons. The piece talks about  the state medical licensing board’s slow process for reviewing complaints against practitioners like high-profile obesity doc Dr. Sheldon Randall. The story is behind the pay wall, but here’s the nut.

Two months ago, the panel suspended Randall’s medical license, accusing him of a pattern of negligence and declaring him an “immediate and serious threat’’ to the public. Investigators charge that he did not recognize and treat post-surgery complications quickly enough in four patients, two of whom died.

Randall, 61, denies the allegations and has appealed the suspension, enlisting a team of experts who said he provided perfectly fine care for those patients. Four prominent Harvard physicians also have written letters to the board supporting him.

Click here is you have a subscription and are signed in. If not, find Sunday’s paper in the library.
Seems like the Globe  should have had this story in August. From the state:

FOR IMMEDIATE RELEASE:                                                                  

Tuesday, August 20, 2013

STATE BOARD OF MEDICINE TAKES DISCIPLINARY ACTION

WAKEFIELD: At its meeting on August 16, 2013, the state Board of Registration in Medicine took disciplinary action against the medical license of Sheldon Randall, M.D.

The Board summarily suspended Dr. Randall’s medical license, finding him an immediate and serious threat to the public health, safety or welfare. The Board based its decision on allegations that Dr. Randall’s treatment of four patients failed to meet the standard of care. Dr. Randall is a 1978 graduate of the Centro de Estudios Universitarios Xochicalco and was first licensed to practice medicine in Massachusetts in 1985.  He practiced general surgery in Medford and Natick.

The Massachusetts Board of Registration in Medicine licenses more than 40,000 physicians, osteopaths and acupuncturists. The Board was created in 1894 to protect the public health and safety by setting standards for the practice of medicine and ensuring that doctors who practice in the Commonwealth are appropriately qualified and competent. The Board investigates complaints, holds hearings and determines sanctions. More information is available at www.mass.gov/massmedboard.

Storify: Coverage of the UMass #Down syndrome/gene silencing study #genetics

BHN Likes Storify but WordPress doesn’t. Click on the picture to go to the full collection of stories on the UMass Down syndrome study.

ss down s

Globe Q & A : BIDMC doc wins poetry award

A nice Q & A in the Globe today with BIDMC internist Dr. Rafael Campo, who is also a poet. Interview by Karen Weintraub.  He recently won the Hippocrates Prize for Poetry and Medicine.

Campo: When we take care of patients we are immersed in stories, in language, in metaphor. Every encounter is a form of poetry, because I think in poetry, we experience immersion in another person’s voice, in another person’s story.

Here’s the opening of a poem called  “Lost in the Hospital”B0000200

It’s not that I don’t like the hospital.
Those small bouquets of flowers, pert and brave.
The smell of antiseptic cleansers.
The ill, so wistful in their rooms, so true.
My friend, the one who’s dying, took me out
To where the patients go to smoke, IV’s
And oxygen in tanks attached to them—
A tiny patio for skeletons…

Local reporters, editors, data crunchers win health journalism awards

A lot of the heath care journalism awards out there are kind of soft — they come from trade or industry groups. They have their own place on our walls, and, in some cases, we appreciate them. (In other cases, an award may represent a conflict of interest.  An award from an institutions you cover? Just say no. )

But the Association of Healthcare Journalists awards come with a lot of cred. And the  New England awards are well deserved. Congratulations colleagues. We get a chance to thank you in person when the AHCJ holds its annual meeting in Boston in two weeks.

ahcj awards-logo

Public Health (Large)

First: Coverage of Fungal Meningitis Outbreak Tied to Contaminated Drugs; Staff, The Boston Globe

Honorable mention: Cancer’s New Battleground: The Developing World; Joanne Silberner, David Baron, PRI’s The World

Consumer/Feature (Large)

Third: A Rampant Prescription, a Hidden Peril; Kay Lazar, Matt Carroll, The Boston Globe

Consumer/Feature (Small)

Second: Gift from Grief; Michael Morton, MetroWest Daily News (Framingham, Mass.)

Third: Demand for Home Care Workers Soaring, But Will There Be Enough Takers?; Arielle Levin Becker, The Connecticut Mirror

 Special citation: 40% of High-Prescribing Docs Get Pharma Perks; Lisa Chedekel, The Connecticut Health Investigative Team

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