KHN: “#Older Americans Are Hooked On #Vitamins Despite Scarce #Evidence They Work.” Not all Boston experts agree that’s a problem.

 

When she was a young physician, Dr. Martha Gulati noticed that many of her mentors were prescribing vitamin E and folic acid to patients. Preliminary studies in the early 1990s had linked both supplements to a lower risk of heart disease.

She urged her father to pop the pills as well: “Dad, you should be on these vitamins, because every cardiologist is taking them or putting their patients on [them],” recalled Gulati, now chief of cardiology for the University of Arizona College of Medicine-Phoenix.

But just a few years later, she found herself reversing course, after rigorous clinical trials found neither vitamin E nor folic acid supplements did anything to protect the heart. Even worse, studies linked high-dose vitamin E to a higher risk of heart failure, prostate cancer and death from any cause.

“‘You might want to stop taking [these],’” Gulati told her father.

More than half of Americans take vitamin supplements, including 68 percent of those age 65 and older, according to a 2013 Gallup poll. Among older adults, 29 percent take four or more supplements of any kind, according to a Journal of Nutrition study published in 2017.

greetings-from-bostonOften, preliminary studies fuel irrational exuberance about a promising dietary supplement, leading millions of people to buy in to the trend. Many never stop. They continue even though more rigorous studies — which can take many years to complete — almost never find that vitamins prevent disease, and in some cases cause harm.

“The enthusiasm does tend to outpace the evidence,” said Dr. JoAnn Manson, chief of preventive medicine at Boston’s Brigham and Women’s Hospital.

There’s no conclusive evidence that dietary supplements prevent chronic disease in the average American, Manson said. And while a handful of vitamin and mineral studies have had positive results, those findings haven’t been strong enough to recommend supplements to the general U.S. public, she said.

The National Institutes of Health has spent more than $2.4 billion since 1999 studying vitamins and minerals. Yet for “all the research we’ve done, we don’t have much to show for it,” said Dr. Barnett Kramer, director of cancer prevention at the National Cancer Institute.

In Search Of The Magic Bullet

A big part of the problem, Kramer said, could be that much nutrition research has been based on faulty assumptions, including the notion that people need more vitamins and minerals than a typical diet provides; that megadoses are always safe; and that scientists can boil down the benefits of vegetables like broccoli into a daily pill.

Vitamin-rich foods can cure diseases related to vitamin deficiency. Oranges and limes were famously shown to prevent scurvy in vitamin-deprived 18th-century sailors. And research has long shown that populations that eat a lot of fruits and vegetables tend to be healthier than others.

But when researchers tried to deliver the key ingredients of a healthy diet in a capsule, Kramer said, those efforts nearly always failed.

It’s possible that the chemicals in the fruits and vegetables on your plate work together in ways that scientists don’t fully understand — and which can’t be replicated in a t

ablet, said Marjorie McCullough, strategic director of nutritional epidemiology for the American Cancer Society.

And although there are more than 90,000 dietary supplements from which to choose, federal health agencies and advisers still recommend that Americans meet their nutritional needs with food, especially fruits and vegetables.

Also, American food is highly fortified — with vitamin D in milk, iodine in salt, B vitamins in flour, even calcium in some brands of orange juice.

Without even realizing it, someone who eats a typical lunch or breakfast “is essentially eating a multivitamin,” said journalist Catherine Price, author of “Vitamania: How Vitamins Revolutionized the Way We Think About Food.”

That can make studying vitamins even more complicated, Price said. Researchers may have trouble finding a true control group, with no exposure to supplemental vitamins. If everyone in a study is consuming fortified food, vitamins may appear less effective.

The body naturally regulates the levels of many nutrients, such as vitamin C and many B vitamins, Kramer said, by excreting what it doesn’t need in urine. He added: “It’s hard to avoid getting the full range of vitamins.”

Not all experts agree. Dr. Walter Willett, a professor at the Harvard T.H. Chan School of Public Health, says it’s reasonable to take a daily multivitamin “for insurance.” Willett said that clinical trials underestimate supplements’ true benefits because they aren’t long enough, often lasting five to 10 years. It could take decades to notice a lower rate of cancer or heart disease in vitamin takers, he said.

Vitamin Users Start Out Healthier

For Charlsa Bentley, 67, keeping up with the latest nutrition research can be frustrating. She stopped taking calcium, for example, after studies found it doesn’t protect against bone fractures. Additional studies suggest that calcium supplements increase the risk of kidney stones and heart disease.

“I faithfully chewed those calcium supplements, and then a study said they didn’t do any good at all,” said Bentley, from Austin, Texas. “It’s hard to know what’s effective and what’s not.”

Bentley still takes five supplements a day: a multivitamin to prevent dry eyes, magnesium to prevent cramps while exercising, red yeast rice to prevent diabetes, coenzyme Q10 for overall health and vitamin D based on her doctor’s recommendation.

Like many people who take dietary supplements, Bentley also exercises regularly — playing tennis three to four times a week — and watches what she eats.

People who take vitamins tend to be healthier, wealthier and better educated than those who don’t, Kramer said. They are probably less likely to succumb to heart disease or cancer, whether they take supplements or not. That can skew research results, making vitamin pills seem more effective than they really are.

Faulty Assumptions

Preliminary findings can also lead researchers to the wrong conclusions.

For example, scientists have long observed that people with high levels of an amino acid called homocysteine are more likely to have heart attacks. Because folic acid can lower homocysteine levels, researchers once hoped that folic acid supplements would prevent heart attacks and strokes.

In a series of clinical trials, folic acid pills lowered homocysteine levels but had no overall benefit for heart disease, Lichtenstein said.

Studies of fish oil also may have led researchers astray.

When studies of large populations showed that people who eat lots of seafood had fewer heart attacks, many assumed that the benefits came from the omega-3 fatty acids in fish oil, Lichtenstein said.

Rigorous studies have failed to show that fish oil supplements prevent heart attacks. A clinical trial of fish oil pills and vitamin D, whose results are expected to be released within the year, may provide clearer questions about whether they prevent disease.

But it’s possible the benefits of sardines and salmon have nothing to do with fish oil, Lichtenstein said. People who have fish for dinner may be healthier due to what they don’t eat, such as meatloaf and cheeseburgers.

“Eating fish is probably a good thing, but we haven’t been able to show that taking fish oil [supplements] does anything for you,” said Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic Foundation.

(Story continues below.)

Too Much Of A Good Thing?

Taking megadoses of vitamins and minerals, using amounts that people could never consume through food alone, could be even more problematic.

“There’s something appealing about taking a natural product, even if you’re taking it in a way that is totally unnatural,” Price said.

Early studies, for example, suggested that beta carotene, a substance found in carrots, might help prevent cancer.

In the tiny amounts provided by fruits and vegetables, beta carotene and similar substances appear to protect the body from a process called oxidation, which damages healthy cells, said Dr. Edgar Miller, a professor of medicine at Johns Hopkins School of Medicine.

Experts were shocked when two large, well-designed studies in the 1990s found that beta carotene pills actually increased lung cancer rates. Likewise, a clinical trial published in 2011 found that vitamin E, also an antioxidant, increased the risk of prostate cancer in men by 17 percent. Such studies reminded researchers that oxidation isn’t all bad; it helps kill bacteria and malignant cells, wiping them out before they can grow into tumors, Miller said.

“Vitamins are not inert,” said Dr. Eric Klein, a prostate cancer expert at the Cleveland Clinic who led the vitamin E study. “They are biologically active agents. We have to think of them in the same way as drugs. If you take too high a dose of them, they cause side effects.”

Gulati, the physician in Phoenix, said her early experience with recommending supplements to her father taught her to be more cautious. She said she’s waiting for the results of large studies — such as the trial of fish oil and vitamin D — to guide her advice on vitamins and supplements.

“We should be responsible physicians,” she said, “and wait for the data.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

 

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STAT: Meet Boston Children’s #Hospital #specialeffects guy

Three-printers and more. Gregory Loan is a simulation engineer at Boston Children’s Hospital Simulator Program. He makes artificial body parts and mannequins for clinicians to practice on.

More great video from STAT here. 

When should aging doctors retire? Does it depend on the doctor?

When should doctors retire? Depends on the doctor.

Two pieces about aging docs. One story from STAT, one column from the Globe.

 

From Medscape:

“There are many older physicians who have a wealth of experience and who are practicing very well, and the last thing on earth we want to do is discourage those physicians from continuing to practice,” Dr Dellinger said. Among the consequences of that, he added, would be worsening the physician shortage.

“On the other hand, the data are unequivocal that there is, on average, a reduction in cognitive and physical abilities with age…and we need to kindly encourage those who should be reducing their practice to do so,” he said.

According to the review, published online July 19 in JAMA Surgery, research shows that between ages 40 and 75 years, mean cognitive ability drops by more than 20%, but there is large variability individually. Dr Dellinger notes that although the journal is for surgeons, the review is meant for all physicians.

KHN: Now that the Massachusetts Medical Society has”rescinded its longstanding opposition to physician-assisted suicide,” others may follow

As Doctors Drop Opposition, Aid-In-Dying Advocates Target Next Battleground States

khn_logo_facebookWhen the end draws near, Dr. Roger Kligler, a retired physician with incurable, metastatic prostate cancer, wants the option to use a lethal prescription to die peacefully in his sleep. As he fights for the legal right to do that, an influential doctors group in Massachusetts has agreed to stop trying to block the way.

Kligler, who lives in Falmouth, Mass., serves as one of the public faces for the national movement supporting medical aid in dying, which allows terminally ill people who are expected to die within six months to request a doctor’s prescription for medication to end their lives. Efforts to expand the practice, which is legal in six states and Washington, D.C., have met with powerful resistance from religious groups, disability advocates and the medical establishment.

But in Massachusetts and other states, doctors groups are dropping their opposition — a move that advocates and opponents agree helps pave the way to legalization of physician-assisted death.

The American Medical Association, the dominant voice for doctors nationwide, opposes allowing doctors to prescribe life-ending medications at a patient’s request, calling it “fundamentally incompatible with the physician’s role as healer.”

But in December, the Massachusetts Medical Society became the 10th chapter of the AMA to drop its opposition and take a neutral stance on medical aid in dying.

Most of those changes occurred in the past two years. They proved a pivotal precursor to getting laws passed in California, Colorado and Washington, D.C., said Kim Callinan, chief program officer for Compassion & Choices, an advocacy group that supports legalization efforts around the country. (The practice is also legal in Washington, Oregon, Vermont and Montana.)

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The shifts come as doctors’ views evolve: Fifty-seven percent of U.S. doctors supported medical aid in dying in a 2016 Medscape survey, up from 46 percent in 2010.

Because of the medical society’s vote, Massachusetts is the state most likely to legalize medical aid in dying this year, predicted David Stevens, CEO of the Christian Medical & Dental Associations, a national group of 19,000 health professionals that has opposed such laws in every state.

“I think a neutral stance is probably what’s going to push it over,” he said.

Doctors’ opinions are also playing a role in New York, where the New York State Academy of Family Physicians endorsed an aid-in-dying bill, and the state medical society is surveying its members on the subject.

Efforts to legalize the practice have faced pushback nationally: Last year, lawmakers in 27 states introduced aid-in-dying bills, and none passed. And in Congress, Republican lawmakers have launched several attempts to block the District of Columbia from implementing its law.

This year, Compassion & Choices’ Callinan identified New Jersey, New York and Massachusetts as its top three target states.

Peg Sandeen, executive director of Death With Dignity National Center, an aid-in-dying advocacy group based in Oregon, cited Hawaii as another top target. Advocates there are “trying to break the logjam in the legislature,” where the state Senate passed a bill in March, she said. Hawaii came close to legalizing the practice in 2000.

Massachusetts has been a fraught battleground for the right-to-die movement: In 2012, opponents narrowly defeated a referendum that would have legalized the practice. Home to a robust medical hub and Harvard Medical School, the state is a stronghold for academic medicine.

Kligler, who’s 66, has publicly described his interest in using lethal drugs to die on his own terms rather than endure what he expects to be several months of significant pain, fatigue and declining quality of life.

Kligler said he wants other dying people to have the same option: When he used to serve as a hospice physician to cancer patients, he said, patients used to “ask me to help them to die,” but he had no legal way to do so. Kligler is also suing Massachusetts, arguing that terminally ill patients have a constitutional right to medical aid in dying.

“It’s a question of justice,” Kligler said.

When the Massachusetts Medical Society surveyed members last year, 60 percent said they supported medical aid in dying, and 30 percent said they opposed it.

Dr. Barbara Rockett, a surgeon and past president of the medical society, urged fellow doctors to uphold the group’s long-standing opposition to the practice. Doctors should focus on helping dying patients through hospice and palliative medicine, she said.

“To intentionally help them commit suicide is wrong,” Rockett said. Proponents, meanwhile, say the practice is not “suicide” because the patient is already being killed by a terminal disease.

Rockett said she was disappointed that her fellow delegates in the society voted to adopt a neutral stance.

Even with the doctors group stepping out of the way, the latest aid-in-dying bill, dubbed the Massachusetts End of Life Options Act, faces formidable opposition. Catholic groups, a significant force opposing aid in dying nationally, have a robust base in Massachusetts: Over a third of residents are Catholic, second only to Rhode Island.

Catholic groups provided much of the $5.5 million that opponents spent to defeat Massachusetts’ ballot referendum in 2012, outspending proponents by nearly 5-to-1.

The Boston Archdiocese did not respond to repeated requests for comment for this story. But at the time the referendum failed, a spokesman said the church could not afford to lose on this issue in a Catholic stronghold: “If it passes in Massachusetts,” the spokesman said, “it’s a gateway to the rest of the country.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

 

Is there anything worse than making money off old or disabled people in need of care? KHN reports on the #nursinghome shell game.

It links to a Harvard study that make the same connection. This story also ran below the fold in the Sunday NYTimes business section.

Care Suffers As More Nursing Homes Feed Money Into Corporate Webs

Publish by permission. 

khn_logo_facebookMEMPHIS, Tenn. — When one of Martha Jane Pierce’s sons peeled back the white sock that had been covering his 82-year-old mother’s right foot for a month, he discovered rotting flesh.

“It looked like a piece of black charcoal” and smelled “like death,” her daughter Cindy Hatfield later testified. After Pierce, a patient at a Memphis nursing home, was transferred to a hospital, a surgeon had to amputate much of her leg.

One explanation for Pierce’s lackluster care, according to financial records and testimony in a lawsuit brought by the Pierce family, is that her nursing home, Allenbrooke Nursing and Rehabilitation Center, appeared to be severely underfunded at the time, with a $2 million deficit on its books in 2009 and a scarcity of nurses and aides. “Sometimes we’d be short of diapers, sheets, linens,” one nurse testified.

That same year, $2.8 million of the facility’s $12 million in operating expenses went to a constellation of corporations controlled by two Long Island accountants who, court records show, owned Allenbrooke and 32 other nursing homes. The homes paid the men’s other companies to provide physical therapy, management, drugs and other services, from which the owners reaped profits, according to court records.

In what has become an increasingly common business arrangement, owners of nursing homes outsource a wide variety of goods and services to companies in which they have a financial interest or that they control. Nearly three-quarters of nursing homes in the United States — more than 11,000 — have such business dealings, known as related party transactions, according to an analysis of nursing home financial records by Kaiser Health News. Some homes even contract out basic functions like management or rent their own building from a sister corporation, saying it is simply an efficient way of running their businesses and can help minimize taxes.

But these arrangements offer another advantage: Owners can establish highly favorable contracts in which their nursing homes pay more than they might in a competitive market. Owners then siphon off higher profits, which are not recorded on the nursing home’s accounts.

The two Long Island men, Donald Denz and Norbert Bennett, and their families’ trusts collected distributions totaling $40 million from their chain’s $145 million in revenue over eight years — a 28 percent margin, according to the judge’s findings of fact. In 2014 alone, Denz earned $13 million and Bennett made $12 million, principally from their nursing home companies, according to personal income tax filings presented in court.

Typical nursing home profits are “in the 3 to 4 percent range,” said Bill Ulrich, a nursing home financial consultant.

In 2015, nursing homes paid related companies $11 billion, a tenth of their spending, according to financial disclosures the homes submitted to Medicare.

In California, the state auditor is examining related party transactions at another nursing home chain, Brius Healthcare Services. Rental prices to the chain’s real estate entities were a third higher than rates paid by other for-profit nursing homes in the same counties, according to an analysis by the National Union of Healthcare Workers.

Such corporate webs bring owners a legal benefit, too: When a nursing home is sued, injured residents and their families have a much harder time collecting money from the related companies — the ones with the full coffers.

After the Pierce family won an initial verdict against the nursing home, Denz and Bennett appealed, and their lawyer, Craig Conley, said they would not discuss details of the case or their business while the appeal was pending.

“For more than a decade, Allenbrooke’s caregivers have promoted the health, safety and welfare of their residents,” Conley wrote in an email.

Dr. Michael Wasserman, the head of the management company for the Brius nursing homes, called corporate structures a “nonissue” and said, “What matters at the end of the day is what the care being delivered is about.”

Networks of jointly owned limited liability corporations are fully legal and used widely by other businesses, such as restaurants and retailers. Nonprofit nursing homes sometimes use them as well. Owners can have more control over operations — and better allocate resources — if they own all the companies. In many cases, industry consultants say, a commonly owned company will charge a nursing home lower fees than an independent contractor might, leaving the chain with more resources.

“You don’t want to pay for someone else to make money off of you,” Ulrich said. “You want to retain that within your organization.”

But a Kaiser Health News analysis of federal inspection and quality records reveals that nursing homes that outsource to related organizations tend to have significant shortcomings: They have fewer nurses and aides per patient, they have higher rates of patient injuries and unsafe practices, and they are the subject of complaints almost twice as often as independent homes.

“Almost every single one of these chains is doing the same thing,” said Charlene Harrington, a professor emeritus of the School of Nursing at the University of California-San Francisco. “They’re just pulling money away from staffing.”

Early Signs Of Trouble

Martha Jane Pierce moved to Allenbrooke in 2008 in the early stages of dementia. According to testimony in the family’s lawsuit, her children often discovered her unwashed when they visited, with an uneaten, cold meal sitting beside her bed. Hatfield said in court that she had frequently found her mother’s bed soaked in urine. The front desk was sometimes vacant, her brother Glenn Pierce testified.

“If you went in on the weekend, you’d be lucky to find one nurse there,” he said in an interview.

After a stroke, Pierce became partly paralyzed and nonverbal, but the nursing home did not increase the attention she received, said Carey Acerra, one of Pierce’s lawyers. When Pierce’s children visited, they rarely saw aides reposition her in bed every two hours, the standard practice to prevent bedsores.

“Not having enough staffing, we can’t — we weren’t actually able to go and do that,” one nurse, Cheryl Gatlin-Andrews, testified in a deposition.

KHN’s analysis of federal inspection, staffing and financial records nationwide found shortcomings at other homes with similar corporate structures:

Homes that did business with sister companies employed, on average, 8 percent fewer nurses and aides.
As a group, these homes were 9 percent more likely to have hurt residents or put them in immediate jeopardy of harm, and amassed 53 validated complaints for every 1,000 beds, compared with the 32 per 1,000 that inspectors found credible at independent homes.
Homes with related companies were fined 22 percent more often for serious health violations than were independent homes, and penalties averaged $24,441 — 7 percent higher.

(Story continues below.)

For-profit nursing homes employ these related corporations more frequently than nonprofits do, and have fared worse than independent for-profit homes in fines, complaints and staffing, the analysis found. Their fines averaged $25,345, which was 10 percent higher than fines for independent for-profits, and the homes received 24 percent more substantiated complaints from residents. Overall staffing was 4 percent lower than at independent for-profits.

Ernest Tosh, a plaintiffs’ lawyer in Texas who helps other lawyers untangle nursing company finances, said owners often exerted control by setting tight budgets that restricted the number of nurses the homes could employ. Meanwhile, “money is siphoned out to these related parties,” he said. “The cash flow gets really obscured through the related party transactions.”

The American Health Care Association, which represents nursing homes, disputed any link between related businesses and poor care. “Our members strive to provide quality care at an affordable cost to every resident,” the group said in a statement. “There will always be examples of exceptions, but those few do not represent the majority of our profession.”

‘Piercing The Corporate Veil’

The model of placing nursing homes and related businesses in separate limited liability corporations and partnerships has gained popularity as the industry has consolidated through purchases by publicly traded companies, private investors and private equity firms. A 2003 article in the Journal of Health Law encouraged owners to separate their nursing home business into detached entities to protect themselves if the government tried to recoup overpayments or if juries levied large negligence judgments.

“Holding the real estate in a separate real-property entity that leases the nursing home to the operating entity protects the assets by making the real estate unavailable for collection by judgment creditors of the operating entity,” the authors wrote. Such restructuring, they added, was probably not worth it just for “administrative simplicity.”

In 2009, Harvard Medical School researchers found the practice had flourished among nursing homes in Texas, which they studied because of the availability of state data. Owners had also inserted additional corporations between them and their nursing homes, with many separated by three layers.

To bring related companies into a lawsuit, attorneys must persuade judges that all the companies were essentially acting as one entity and that the nursing home could not make its own decisions. Often that requires getting access to internal company documents and emails. Even harder is holding owners personally responsible for the actions of a corporation — known as “piercing the corporate veil.”

At a 2012 Nashville conference for executives in the long-term health care industry, a presentation slide from nursing home attorneys titled “Pros of Complex Corporate Structure” stated: “Many plaintiffs’ attorneys will never conduct corporate structure discovery because it’s too expensive and time consuming.” The presentation noted another advantage: “Financial statement in punitive damages phase shows less income and assets.”

A lawyer in Alabama, Barry Walker, is still fighting an 11-year-old case against another nursing home then owned by Denz and Bennett, according to court records. Walker traced the ownership of Fairfield Nursing and Rehabilitation Center back to the men, but he said the judge had allowed him to introduce the ownership information only after the Alabama Supreme Court ordered him. That trial ended with a hung jury, and Walker said a subsequent judge had not let him present all the information to two other juries, and he dropped the men from the lawsuit. The home closed a few years ago but the case is still ongoing despite two mistrials.

“The former trial judge and the current trial judge quite frankly don’t seem to understand piercing the corporate veil,” he said. “My firm invested more in the case than we can ever hope to recover. Sometimes it’s a matter of principle.”

The complexity of the ownership in Pierce’s case was a major reason it took six years to get to a trial, said Ken Connor, one of the lawyers for her family. “It requires a lot of digging to unearth what’s really going on,” he said. “Most lawyers can’t afford to do that.”

The research paid off in a rare result: In 2016, the jury issued a $30 million verdict for negligence, of which Denz and Bennett were personally liable for $20 million. The men’s own tax returns bolstered the case against them. They claimed during trial they delegated daily responsibilities for residents to the home’s administrators, but they reported on their tax returns that they “actively” participated in the management. The jury did not find the nursing home responsible for Pierce’s death later in 2009.

The fight is not over. Denz and Bennett are appealing the verdict, the damages, their inclusion and the trial judge’s decisions. They argue that Tennessee courts should not have jurisdiction over them since they spent little time in the state and neither was involved in the daily operations of the home or in setting staffing levels. Their lawyers said jurors should never have heard from nurses who hadn’t cared directly for Pierce.

“No way did I oversee resident care issues,” Bennett testified in a deposition.

Deficient In The End

Whoever was responsible for Pierce’s care, her family had no doubt it was inadequate. Her son Bill Pierce was so horrified when he finally saw the wound on his mother’s foot, he immediately insisted that she go to the hospital.

“The surgeon said he had never seen anything like it,” Hatfield said in an interview. “He amputated 60 percent of the leg, above the knee.”

After her amputation, Pierce returned to the nursing home because her family did not want to separate her from her husband, who was also there.

At the trial, the nursing home’s lawyers argued that Pierce’s leg had deteriorated not because of the infection but because her blood vessels had become damaged from a decline in circulation. The jury was unpersuaded after nurses and aides testified about how Allenbrooke would add staffing for state inspections while the rest of the time their pleas for more support went unheeded.

Workers also testified that supervisors had told them to fill in blanks in medical records regardless of accuracy. One example: Allenbrooke’s records indicated that Pierce had eaten a full meal the day after she died.

Data journalist Elizabeth Lucas contributed to this report.

BI: Partner’s #security chief warns:”You can do a lot with the information contained in a #healthrecord,” including get a credit card.

partners gatewayBusiness Insider quotes MGH Chief Medical Officer O’Neil Britton who spoke at Hub Week on hospital cybersecurity.

We have 72,000 employees with credentials to log into our computer system,” says O’Neill. “Our network has many components, including a financial clearance system and an electronic health records database. Not all 72,000 employees can get into each component, but having this number of people can make it easier for criminals to access our network with a phishing attack, for example.” (He emphasized that his organization has implemented some robust anti-phishing training for employees.)

Despite enabling great convenience, technology can also increase the potential for harm. “You can do a lot with the information contained in a health record: get a mortgage, file insurance claims, open a credit card, get a mortgage,” says Jagar Kadakia, Chief Information Security and Privacy Officer of Boston-based Partners HealthCare. “It’s way more valuable than a credit card number.” To steal a few thousand paper records would require a truck. To steal the social security numbers, addresses, and driver’s license data for 136 million Americans would only require a USB drive. I

Could the decline in #prostatecancer diagnoses usher in an increase in death rates? #cancer screening

CaptureThere are a lot of problems with cancer screening. Explaining and understanding the calculus behind the tests is not easy.  Suffice to say that early detection is generally not the life saver we thought it would be.

Now comes a steep decline in prostate cancer diagnoses. Harvard’s Meir Stampfer asks where that’s good news or bad news. Writing mostly behind the pay wall in JAMA Oncology he notes:

Prostate cancer rates in the United States are down—sharply… a decline of 53% since 1992, when prostate-specific antigen (PSA) screening became widespread. This decrease is likely attributable to 2 factors. First, after more than 3 decades of widespread PSA screening to detect prostate cancer, there are few men with high PSA levels that haven’t already been diagnosed. Second, and perhaps more important, PSA screening is now becoming less common.In 2008, the US Preventive Services Task Force (USPSTF) advised against PSA screening for men older than 75 years. Screening then declined in all age groups.

He cites a study release this past fall, that found screening reduces mortality. It follows another study that found no reduction.

The questions is, he ask –will drop in mortality stop or reverse as screening declines?

Stampfer note that here is a lot of undiagnosed prostate cancer out there. Most cases, he writes, will never cause harm. Some will, but the PSA test is not specific enough to sort out the lethal cases. Watch at wait is one response. But, if the cases are never diagnosed, no one will be watching.

So, good or bad news? He’ll address that question on Wednesday, January 10, at the Harvard School of Public Health.  Details here. 

Worth noting that, according to Health News Review, a recent study “confirms what we already know about the PSA test — that it involves trade-offs including financial costs and long-term harms from screening in exchange for what appears to be very few numbers of lives saved. It is in knowing and understanding these trade-offs that men can be sure that they are going into a PSA test with their eyes wide open.”