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.”

Boston hospital CIO Halamka on his wife’s diagnosis: “We have cancer”

Beth Israel CIO John Halamka usually blogs about health information with posts like “The EHR/HIE Interoperability Workgroup,” and very occasionally, his life as a vegan or his plan to  retire to a small family farm to raise organic vegetables.

Today he reports the disturbing news of his wife’s breast cancer. They’ve decided to document her treatment in real time.

The headline “We have cancer.”

Last Thursday, my wife Kathy was diagnosed with poorly differentiated breast cancer. She is not facing this alone. We’re approaching this as a team, as if together we have cancer. She has been my best friend for 30 years. I will do whatever it takes to ensure we have another 30 years together.

She’s has agreed that I can chronicle the process, the diagnostic tests, the therapeutic decisions, the life events, and the emotions we experience with the hope it will help other patients and families on their cancer treatment journey.

Boston Globe editorial: Prostate screening limits “too sweeping”

A staff editorial in today’s Globe echoes comment made by prominent docs in town: The US Preventative Services Task Force went too far in calling for limits on prostate screening.

A better course would be for physicians to talk with their patients about both the uncertainties inherent in the PSA test and the relative innocuousness of most prostate cancers. Some patients may find the panel’s recommendation reason enough to forgo the test. Others patients might prefer to have it done, but to monitor their PSA levels rather than seek immediate treatment when the results are borderline.

Insurance companies often use the panel’s recommendations as their criterion for whether to cover a test. But until there’s a better test to detect prostate cancer or a broader consensus about skipping this one, insurers should continue to cover it.

Note that The New York Times editorial staff supports the limits and notes that the USPSTF guidelines allow for doctor patient conversations:

Critics, including urologists, who diagnose and treat prostate cancer, charge that the task force’s recommendations are misguided and will hurt patients. They have already been held up for two years lest they ignite charges of government rationing. That’s absurd. The recommendations are intended as guidance to help men and their doctors decide whether to use the test and how to react if it is positive. This is information patients need to know.       

 

Health reform and cancer: Mass can’t get either one right?

Fortune/CNN jumps all over Mass health reform

 …(T)he plans offer lavish subsidies that swell the demand for health care, they do nothing to increase the supply of medical services in a market suffering from shortages of everything from family doctors to nurses to hospital beds. Two years after enacting health-care reform to rein in costs, Massachusetts strengthened “certificate of need laws” that prevent hospitals and other providers from competing with high-cost, entrenched suppliers. The state now requires that ambulatory surgical centers and outpatient treatment facilities get permission from regulators before they can enter the market. Their rivals invariably lobby the regulators to block competition, and usually win.

 And, the NY Times holds up MGH research as an example of the limits of targeted cancer therapies.

 Enthusiasts for the targeted drug have been saying for years that tumors will eventually be characterized by their molecular profiles — which mutated genes they have — rather than where in the body they occur. Names like breast cancer and lung cancer will be supplanted by terms like B-RAF-positive or EGFR-positive tumors. And drugs will be chosen based on that profile, the way antibiotics are generally selected based on the pathogen that is causing the infection, not on where in the body the infection occurs.

 Massachusetts General Hospital, for instance, is running a clinical trial testing a drug from AstraZeneca on any type of cancer — providing it has a mutation in the gene B-RAF, the same gene that is the target of PLX4032.

 But the test of PLX4032 in colon cancer suggests that the location of the tumor still does matter, that it will not be just a case of looking at the target. There are other examples as well. Erbitux and Vectibix do not work in colon cancer patients with a mutation in a gene called K-RAS. But the relationship between the mutation and the effectiveness of Erbitux does not seem to hold in lung cancer.

 

Get ready for cancer research hope/hype fest

For some help on how to process the tidal wave of cancer research news coming out of the American Society of Clinical Oncologists meeting, see Nature Network Boston. 

For an unfiltered view, Twitter is spewing information, including tweets from Dana Farber and Mass General.

Malcolm Gladwell on Massachusetts cancer research

In this week’s New Yorker, Malcolm Gladwell uses the history of leukemia drugs to get into a tale of the ongoing search for effective cancer treatments. He followed compound know as elesclomol from a successful Phase 2 studies through several Phase 3 clinical trials.  His main character is emeritus Harvard researcher Lan Bo Chen, who co-founded Lexington’s Synta Pharmaceuticals and did much of the research on elesclomol.  

When life-saving radiation turns deadly

Walt Bogdanich of the NY Times followed up on reports of radiation overdoses for cancer patients in Florida and Philadelphia. He found horrific medical errors and little oversight. His story ran on Sunday, 1/26.

Americans today receive far more medical radiation than ever before. The average lifetime dose of diagnostic radiation has increased sevenfold since 1980, and more than half of all cancer patients receive radiation therapy. Without a doubt, radiation saves countless lives, and serious accidents are rare.

But patients often know little about the harm that can result when safety rules are violated and ever more powerful and technologically complex machines go awry. To better understand those risks, The New York Times examined thousands of pages of public and private records and interviewed physicians, medical physicists, researchers and government regulators.

The Times found that while this new technology allows doctors to more accurately attack tumors and reduce certain mistakes, its complexity has created new avenues for error — through software flaws, faulty programming, poor safety procedures or inadequate staffing and training. When those errors occur, they can be crippling.

While the Times stories are about radiation therapy, Neuroradiologist Michael Lev of Massachusetts General Hospital argues for quality assurance to CT scans in the current American Journal of Neuroradiology

Because of incorrect settings on the CT scanner console, more than 200 patients over a period of 18 months received radiation doses that were approximately 8 times the expected level. While this event involved a single kind of diagnostic test at 1 facility, the magnitude of these overdoses and their impact on the affected patients were significant. About 40% of the patients lost patches of hair as a result of the overdoses.

This episode highlights the importance of CT quality assurance programs

Coffee and prostate cancer: Not what you think

That wacky comic hero Too Much Coffee Man will rejoice!

A new Harvard study has found that men who drink 1 to 3 cups of coffee a day had a 20 percent lower risk of serious prostate cancer than non-coffee drinkers. The risk is 25 percent lower for those who 4 or 5 cups.

As Bloomberg reports:

In research involving 50,000 men over 20 years, scientists led by Kathryn Wilson at Harvard’s Channing Laboratory found that the 5 percent of men who drank 6 or more cups a day had a 60 percent lower risk of developing the advanced form of the disease than those who didn’t consume any.

Hear us now — This does NOT mean coffee prevents prostate cancer. All this type of study measures is correlation — not cause and effect. But, that’s a pretty strong correlation.

And, don’t get all hyper about it. Decaf had the same effect.

Health Wonk Review: Killer viruses and the undead public option

t camera oct09 064Killer viruses, computers that see all, and the undead public option. (Or, as Jon Stewart said last night –”It’s alive!“) Welcome to the haunted edition of the Health Wonk Review –  the  floating digest of posts from the health policy blogosphere. This week, we put the death back into death panels.

 The health care system is an out-of-control beast,  promising to heal us while sucking more and more out of our pockets. The shadowy Blob of the drug, device and insurance industries threatens to absorb a larger share of the GNP each year. (So do hospitals and some docs, but they have always worn their halos and angel costumes.) One time, a mob of angry Medicare recipients chased down a Congressman like a scene from Night of the Living Dead. But, the situation has become even more frightening. Until recently, people didn’t come to town meetings with guns to yell at at their reps and senators like crazed Jack Nicholson at the end of The Shining. There were no pictures of either Clinton with a Hitler mustache. t camera oct09 066And, who knows what other secrets lie behind closed White House doors beside deals with drug makers.

In honor of Halloween, BHN offers a costume theme. Add your own. Or go to the end and add a comment with your nominee for the scariest ever doctor, nurse, lawmaker, lobbyist  or other healthcare player — real or imagined. I vote for the twin gynecologists, both played by Jeremy Irons, in the movie “Dead Ringers.”  They made their own medical instruments.

 Cancer Screening: Two-Face from Batman

 Here at Boston Health News, we thought it was huge that The American Cancer Society finally admitted that cancer screening has been oversold. The push for screening is seen as model of a successful health campaign. So successful that people don’t want to believe that, in many cases, the value of early detection is a myth.  

Dr. Anthony Horan’s article on the Health Care Blog  Putting Profit before Patient ” contends that the current method of using PSA blood tests to screen for prostate cancer often causes more harm than good.

Then, there are some screening tests that work — like the pap smears and colonoscopies. But, most people don’t get colonscopies when they need them, says  National Committee for Quality Assurance (NCQA) president Margaret E. O’Kane. She blogs on the agency’s “The State of Health Care Quality 2009″ report. The report includes good news -almost all of the 30 million Americans living with asthma are getting care. But, there are problems too. Only 42.5 percent of people are receiving colon cancer screening at the appropriate age. O’Kane recommends that Congress create insurance exchanges, tie payment systems to performance and standardize measures for public reporting.

H1N1: Virus shedding monster  

killer fluDespite new movement on health reform, the arrival of H1N1 and the shortage of vaccines is generating a lot of news. On the Disease Management Care Blog, Jaan Sidorov “points out that it may not be the fault of the Obama Administration’s but it is certainly responsible for the H1N1 vaccine shortages. This may have implications on how the Government will handle the rest of the nation’s health and could give another opening to opponents of health care reform.”

The Public option:  Devil or Superhero

 Here we get silly.

 Healthcare Technology News reports on a bit of harmonization in “Guerilla Music at the AHIP Conference.”

“On Friday October 23, America’s Health Insurance Plans (AHIP) met in the aftermath of a tumultuous month in which the health insurance companies’ lobbying operation released a study it commissioned which, according to the White House is “an attempt to confuse the debate around health reform…Just when the insurance industry must feel that it couldn’t get any worse, attendees at the AHIP conference were subjected to this guerilla music by “Public Option Annie.”

Health policy poet Madeleine Begun Kane offers this limerick urging the president to play a stronger role in bringing about the public option. (Too bad Obama vacationed in Martha’s Vineyard and not Nantucket.)

“Recent comments by Sen. Jay Rockefeller and others indicate
that a strong public option could become a reality, if only President Obama stopped being a Bystander President.”

postcardBystander President?

Public option’s at stake — tock, tick, tock.
Please step up to the plate, Dear Barack.
Though the sidelines were cool
For a while, you’re a fool
If you fail to ensure it’s a lock
.”

—–

Participatory medicine: Pirates

Jane Sarasohn-Kahn at Health Populi reports  on The Center for Connected Health and “the launch of the new Journal of Participatory Medicine. We can’t bend the cost curve without engaging people in their own health care.”

The Health Blawg’s David Harlow also  attended the Connected Health Symposium offering this: “Given the crushing cost of hospital-based health care services, the current and growing primary care physician shortage, and the expectation of high-quality health care services accessible to all, the Center for Connected Health is letting us all know that the road to the future is the information superhighway, paved with intelligent payment reforms — but that the nodes in the network will always be human beings.

Medicare: Uncle Fester

t camera oct09 065 The AMA argues that Medicare doesn’t pay doctors enough. The AMA threatens that, unless Congress passes a bill called “The Medicare Physicians Fairness Act ” physicians will be forced to stop seeing Medicare patients, who are already worried about the stability of the program.”

Granny killers!

Really, don’t they say that every time Congress tries to limit increases in Medicare Part B?  Joe Paduda at Managed Care Matters give a quick history of the program to control Medicare Part B costs that this bill would override and worries “Where are we going to come up with a quarter trillion dollars?”

Quality of Care: Angel  v. Dr. Sawbones

t camera oct09 051 Mike King  at Healthy Debate writes about how malpractice insurers recent years reduced the premiums they charge physicians. Some “at least scaled back annual premium increases that were common before reform. But there is no evidence to show that has led to a corresponding reduction in physician charges to patients.”

HIT  : Frankenstien (Lots of pieces. Can we put them together and make them work?)

David Williams at the Health Business blog says telemedicine has the potential to dramatically increase the level of competition among health care providers, resulting in reduced costs.

IMG_1868The e-CareManagement blog suggests Senator Chuck Grassley probe more deeply into electronic medical records and patient safety.: “You’re on Track about EMR Problems, But Here Are Some More Questions to Ask”

Health 2.0 and the Big Bang, from 10/13 ehrbloggers.com : A review of the recent Health 2.0 conference in San Francisco “warns that conference organizers risk being seen as “all things to all people” if they don’t define what they want the term, “Health 2.0″ to stand for…and such a move, while financially lucrative in the short term (for the organizers), risks diluting any potential impact they wish to have on national policy…a mistake similar to the one made in the early 1990s by leaders (including myself) of the TQM movement.”

The Healthcare IT Guy– aka Shahid N. Shah  – gets a little acronymy on us. But ,we are self described wonks so here  it is:  “All healthcare organizations need to be aware of a problem that’s probably bigger than the Year 2000 (Y2k) migration – the ICD10 and HIPAA 5010 migration. A huge fiscal burden has been placed on payers and providers as they look to redesign business processes and systems to handle hundreds of thousands of new codes at an estimated cost of more than $14 billion

 Insurance: Dr. Jekyll and Mr. Hyde

t camera oct09 047

Roy Poses at HC Renewal wonders why we see nothing in health services research and medical literature about a potential solution to high health costs –”a repeal of a law around since 1945 that insulated health insurance from government anti-trust regulation, appear in the media.  As far as I can tell, the possibly causal role of this law, and whether it needed repeal never has been discussed in the above literature, a striking illustration of the anechoic effect (i.e., certain topics in health care rarely are discussed because doing so may offend powerful interests).

 The Health Access Blog analyzes objections to “employer responsibility” section of Senate Finance Committee. A section of the bill would require employers who don’t offer coverage to potentially pay $1,000s per employee. The fee applies to those who work at least 30 hours a week who receive subsidies to purchase coverage in a health insurance exchange. The fear — all the low-wage workers will get their hours cut to 29 a week. More here.

 The Health Affairs Blog reports on as paper entitled: Are Higher-Value Care Models Replicable? A Boeing Company pilot “shows that enhancing care via a ‘medical home’ designed explicitly for patients with severe chronic disease can improve quality of care and reduce per capita spending in well-led physician organizations without a long history of national clinical distinction.”

t camera oct09 063From Worker Comp Insider: Attorneys General in three states have put FedEx on alert for “widespread, long-term, and unlawful employment practices.” Jon Coppelman of Workers Comp Insider “looks at these new challenges to the company’s practice of classifying its drivers as independent contractors rather than employees, which leaves the drivers out in the cold when it comes to the safety net of workers comp coverage for work-related injuries – not to mention the protections of other basic labor laws.”

Obama Healthcare 2009 suggests that “Unions are supportive of the House health care reform bill , even though as a practical matter the bills discriminate against union workers.”

Food : The Headless Horseman

t camera oct09 062 Of Carrot Cake and Oreos : The New America Foundation’s Joanne Kenen spent an afternoon with Dr. David Kessler, “talking about carrot cake, Oreos  , policy, parenting and why the American diet is the biggest public health care challenge of our times. “

Healthcare Hacks ask — Should we tax soda?

 Financing — Banker from Monopoly or Hobo

Drug Channels.net offers an analysis of the CBO review of Baucus bill and its implications for Pharmacy Benefit Managers (PBMs) and pharmacies: “Retail pharmacies would benefit from increased prescription volume but will likely see gross margins drop as the uninsured get the advantage of third-party bargaining power,” says Adam J. Fein, Ph.D.

t camera oct09 067Free-market supporter and health policy grad student John J. Leppard  says Obama’s approach is flawed and should be dumped. On his Healthcare Manumission blog, he asks: “With all the talk about reforming health care going on, I’m a little surprised that no one is actually talking about health care reform.”

Uninsured: Circus performer, no net

College students who want to take a break from school to cope with a serious illness get more bad news when they file their claims. Many insurers won’t cover dependents over 18 unless they are in school full time.

Henry Stern of InsureBlog comments on Michelle’s Law, which aims to change that.  “A college student has to choose between life-saving treatment and losing her insurance to pay for it. InsureBlog reports on a new law forbidding carriers from dropping students in this frightening position.”

Finally to bring to all back home to the land of Lizzie Borden and the Salem witch trials,  the Health Reform Galaxy Blog tells us: The secrets of Massachusetts’ success (including bigger carrots and smaller sticks)

Thanks to my East Cambridge neighbors for allowing me to showcase their annual haunted house.

tr-tg-halloween-04-crop

Oct. 31, 2004

Screening for Cancer Questioned

BHN thinks this it is huge that the American Cancer Society finally admitted that cancer screening sometimes leads to overdiagnosis.

Or did they? This blog item from the Associations of Health Care Journalists notes that ACS backpedaled a day after the NYTimes reported on the society’s change of heart. Check out their links too.  

(Times writer Gina) Kolata’s story was published on Tuesday. On Wednesday, the ACS released a statement from Brawley in which he says the organization stands by its screening recommendations.

Here’s why the mantra  of early detection is a problem. We’ve gotten better at finding cancer but we are not very good at sorting the nasty ones out from the tumors that will never grow. If you have a raging tumor, it doesn’t seem to matter when you find it. And, yes, some malignant tumors –possibly quite a few — never grow.  The concept of early detection was a very successful health campaign. Too bad, in many cases, it was wrong.

Gary Schwitzer of  University of Minnesota School of Journalism believes in evidence-based reporting.  He’s been following the follow-ups on this story and isn’t happy.

New media writer Jeff Jarvis, recently diagnosed and treated for prostate cancer, is writing about screening again: “I say, thank god science for screening.”

 He’s entitled to his opinion. He is not entitled to his own personal version of the facts. He writes: “There is a growing rumble about curtailing screening.”

 No. That is simply wrong. There is no move for “curtailing” screening. There are many, however, who are calling for better and more balanced presentation of the potential harms – not just the potential benefits – of such screening.

The debate over mammography and prostate cancer screening has been around for a while. According to the National Women’s Health Networkfifteen years after the debate about the value of screening mammography first flared up, too many women (and clinicians) still don’t know it’s more complicated than the “early detection is your best prevention” slogan.

The stories of note from the NYTimes. 

 Benefits and Risks of Cancer Screening Are Not Always Clear, Experts Say

Most people believe that finding cancer early is a certain way to save lives. But the reality of cancer screening is far more complicated.

Studies suggest that some patients are enduring aggressive treatments for cancers that could have gone undetected for a lifetime without hurting them. At the same time, some cancers found through screening and treated in the earliest stages still end up being deadly.

As a result, the chief medical officer for the American Cancer Society now says that the benefits of early detection are often overstated. The cancer society says it will continue to revise its public messages about cancer screening as new information becomes available.

And, Gina Kolata’s 10/21 story

The American Cancer Society, which has long been a staunch defender of most cancer screening, is now saying that the benefits of detecting many cancers, especially breast and prostate, have been overstated.

It is quietly working on a message, to put on its Web site early next year, to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.

“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”

As far as mammography goes, Breast Cancer Action has been all over this. In honor of Breast Cancer Awareness month, check out their “Think Before You Pink” campaign while you’re at it.

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