BIDMC’s Haider Warraich in the NYTimes on how false hope harms patients

The NY Times offers a piece in the Sunday Review urging doctors to be straight with dying patients. From BIDMC doc (and novelist) Haider Javed Warraich:

bidmc logoA study of cancer patients and their doctors in the Annals of Internal Medicine a year later found that many doctors didn’t quite tell patients the truth about their prognosis. Doctors were up front about their patients’ estimated survival 37 percent of the time; refused to give any estimate 23 percent of the time; and told patients something else 40 percent of the time. Around 70 percent of the discrepant estimates were overly optimistic.

This optimism is far from harmless. It drives doctors to endorse treatments that most likely won’t save patients’ lives, but may cause them unnecessary suffering and inch their families toward medical bankruptcy.

One source of this optimism is pop culture, which frequently depicts heroic recoveries from seemingly life-threatening situations. Another is the medical school experience. What motivates weary medical students is the hope that one day interventions they perform will save lives, heal families and enact cosmic good.

Haider Warraich also had a piece two weeks ago about witnessing the aftermath of one of the marathon bombs. He had lived through war and violence growing up in Pakistan, he wrote. It did little to prepare him for the Boston blast beyond heightening his fear of looking like a suspect.

More on Warraich and the marathon  from Slate and a bit of audio from The World.

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Get healthier with web games

Beyond exergaming.

The Institute of Medicine anbd HHS will host a public forum today: The Community Health Data Forum: Harnessing the Power of Information to Improve Health in Washington, DC. The morning session will debut a number of recently developed applications that use community health data before an audience of highly influential policymakers and all attendees.

Watch it online.

This Boston-based project will be there: Community Clash is“a Web-based game that allows players to compare their community’s health to other cities.”  

The Institute of Medicine and HHS will host a public forum, The Community Health Data Forum: Harnessing the Power of Information to Improve Health, in Washington, DC. The morning session will debut a number of recently developed applications that use community health data before an audience of highly influential policymakers and all attendees.

The afternoon session includes a series of working groups that will begin at 12:15 p.m. and adjourn at 2:00 p.m. During this session, smaller groups will discuss additional ideas and the needs of various stakeholders with respect to the Community Health Data Initiative and how to translate these opportunities into functioning applications by the end of 2010.

“The short red line gets long — Flu symptoms jump in Mass

BHN has been regularly updating an earlier post. But, it looks like it is time to put H1N1 back on the top of the queue.  

11/5 New state weekly report:

As illustrated in this week’s report, we continue to see dramatic increases in the number of cases of Influenza-like illness (ILI) across the state. This means that it is more important than ever for everyone to follow our flu prevention and control measures.

Not surprisingly, many schools are seeing an increase of H1N1 flu circulating and parents are, understandably, concerned about their children getting sick. We would like to share with you some information on how the Department of Public Health is working with administrators and school nurses across the state to help them prevent the spread of the flu.

 11/5  Sacha Pfeiffer at WBUR has a nice piece on kids with flu symptoms flooding the Childrens Hospital ER and why that’s a bad idea.  Here’s a sidebar on what to do when your kids get sick. (BHN heard the audio on this earlier but there is no link to it on the story’s web page.)

11/4 Boston Business Journal on the randomness of getting an H1N1 shot.

11/4 According to a report from a worker’s rights group “Wal-Mart’s stingy sick-leave policy may contribute to swine flu’s spread.” Workers there are punished for taking too many sick days. Via the fine folks at the Institute for Southern Studies.

The report found that the only time the company is removing sick workers from the food section is when they are coughing too loudly or violently — and then the person is merely transferred to another department rather than being sent home.

11/3 General CDC information for parents of children K-12.  

11/2 — NECN story on H1N1 vaccines clinics in RI and VT. Still reporting no public clinics in Mass. until December.  

11/1 From the AP: Govt says swine flu vaccine catching up to demand.

 10/30  Today’s weekly update of Mass residents with flu like symptoms shows ” a continuous, dramatic increase in ILI (influenza-like illness) activity over the past few weeks in excess of what was seen at the same time the last two years.”

It also includes an update on vaccine availability for n women.

(N)ot all obstetrical practices in Massachusetts are registered to receive the vaccine. This poses a problem for women who go to these providers and who wish to be vaccinated. 

If your doctor is not currently registered to administer H1N1 vaccine, you might recommend that they do so through the DPH website at the DPH vaccine provider registry . Registration is fast and easy, and continues to be open for new registrants. You may also ask your provider to refer you to a medical associate who is enrolled to administer the vaccine.

10/29 From the DPH, More Details About the H1N1 Vaccine Distribution Program

As of today, more than 480,000 doses of H1N1 vaccine have been distributed to providers in Massachusetts –- just the tip of the iceberg of the total 3.5 million doses of vaccine that we expect to receive this flu season. This is not where we expected to be at this point based on what we were initially told by the federal government, and it creates a difficult and frustrating situation for everyone, especially those people at greatest risk of complications from the H1N1 flu… 

10/29 Sacha Pfeiffer at WBUR tries to sort out who is getting the vaccine and who isn’t:With the H1N1 swine flu vaccine in high demand and short supply in Massachusetts and nationwide, people considered “high-risk” are supposed to be vaccinated first. But some high-risk patients can’t find the vaccine even though some seemingly healthier patients can. That has many people wondering if there’s any rhyme or reason to how the vaccine is being divvied up.

10/28: I’m lapsed but go to Mass now and then. I was wondering what it would take to get the Catholic Church to see the risks involved in shaking hands with seven or eight strangers. The Globe reports that it was H1N1 .

10/27 — The latest from the state on access  to the vaccine, or lack of it. Now looking at late November for most people. Their “limited supply is reserved for people at especially high risk for flu, which includes pregnant women, children, caregivers of infants and healthcare workers with direct patient contact. As supplies grow, this will expand to include the additional priority groups of young adults up to the age of 24, and people between the ages of 25 and 64 with underlying health conditions like asthma and diabetes. 

We expect the number of doses of H1N1 vaccine in the state to exceed 1 million by the end of November. As it arrives, we will continue to work to ensure that the vaccine that is available goes to these high priority groups. We thank you for your patience and understanding10/26 H1N1 Mist v. Shot, from the Mass DPH

The H1N1 flu shot in an inactivated vaccine, which means that it contains killed virus. The shot is given with a needle, usually in the arm. The flu shot is approved for use in people 6 months of age and older, including healthy people, people with chronic medical conditions and pregnant women. You can find more information on the H1N1 flu shot in this CDC .pdf file.

 The H1N1 nasal spray flu vaccine is made with live, weakened viruses that do not cause the flu. The spray is sometimes called LAIV for “live attenuated influenza vaccine.” The spray is approved for use in healthy people 2 years to 49 years of age who are not pregnant. More info here.

 On Saturday, Obama just declared H1N1 a “national emergency,” a move that is less alarming than it sounds.

The state DPH posted this  response on Sunday:

The Patrick Administration has conferred with the Massachusetts Hospital Association regarding the President’s declaration and joint efforts are being made to inform hospitals of its content.  The declaration does not increase the pace at which the H1N1 vaccine will become available to the public.  Production delays have decreased the shipments of vaccine to Massachusetts and all other states.  So far in Massachusetts, 300,000 doses of the vaccine have been distributed to clinical sites.  Hundreds of thousands more are expected in the coming weeks.  Public health officials reaffirmed that residents of the state can play an active role in decreasing the spread of the flu by staying home when sick and by carefully practicing health hygiene.

 Also:  The red line on a chart showing the  incidence of flu like symptoms in the state has finally appeared for this year. It is short, as they say, but it is much higher than the line for the two previous years.

Or as the state DPH put it, the line shows a “continuous, dramatic incidence in ILI (influenza type illness ) activity over the past few week.”  

On the national emergency:  From the AP, via the Globe:

The declaration, which the White House announced Saturday, allows HHS in some cases to let hospitals relocate emergency rooms offsite to reduce flu-related burdens and to protect noninfected patients.

Administration officials said the declaration was a pre-emptive move designed to make decisions easier when they need to be made. Officials said this was not in response to any single development on an outbreak that has lasted months and has killed more than 1,000 people in the United States.

You’ll need to be in a high-risk group to get a H1N1 vaccine before November. See the CDC for that list. Check with your doctor or http://flu.masspro.org to find out when the vaccine will be available.  More on vaccine supply here, also from the CDC.

This from the state:

Our top priority is and will remain those members of the public who are at greatest risk.  Initially that category includes children, pregnant women and health care workers.  As supplies allow, we will also target young adults below the age of 25, and 25-64 year olds with certain underlying health conditions.  Public clinics will only be held at the point that there is sufficient volume to shift beyond the focus on these target groups.  The CDC states that eventually there will be enough H1N1 vaccine to protect anyone in the population who wishes to be immunized.

 10/23  Here it comes. This from the Globe:

Flu activity is widespread in Massachusetts for the first time this fall, public health officials said today, leading a Central Massachusetts high school to close its doors until Wednesday and almost certainly reflecting cases caused by the swine flu virus, whose return has been expected since it first emerged in the spring.

 

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.

Health career/EMT training scams

First, the alleged Obama “death panel” has been soundly debunked. See KHN’s morning roundup.

So, no new health care jobs there. But, a lot of people are looking for new careers. I get a lot of spam about training programs for nurses and techs. I imagine some of them are scams. Buyer beware– look for accreditation.

EMT’s skipping their training isn’t exactly the same thing, but it does amount to cutting corners on life or death training. Would you want these guys responding to your 911 call? From the Globe.

The former Hamilton police chief and three other men who allegedly falsified emergency medical training and attempted to cover it up as investigators closed in on them were arraigned this morning in Salem Superior Court.

Walter D. Cullen, the former chief, was charged with two counts of Emergency Medical Services violations, and single counts of procurement fraud and larceny over $250. According to authorities, Cullen, 64, said during an investigation that he had taken required emergency training at the Essex Fire Department in 2006, but the investigation revealed that he was on vacation in Denver and San Diego during that time period and that his son-in-law, Sean Cullen, had actually signed in for him.

State on back-to-school flu issues

From The Boston Globe

Massachusetts health authorities took the unprecedented step yesterday of deputizing dentists, paramedics, and pharmacists to help administer vaccines against both the seasonal flu and the novel swine strain expected to make a return visit in the fall.

From Mass DPH:

We continue our busy summer of planning for the fall flu season.  This week there was a great deal of emphasis on vaccination planning for seasonal influenza and also for novel H1N1 flu.  This year, because of expedited production, Massachusetts may see its supply of seasonal influenza vaccine earlier than ever.  It is likely that health care providers across the state could start vaccinating their patients for seasonal flu as early as the end of August.  This is important because while a vaccine for seasonal influenza won’t protect you from the new H1N1 flu, it WILL protect you from the seasonal flu — which will likely be circulating at the same time that H1N1 flu is circulating…

Simple Precautions to Help Stop the Spread of Flu Include:

  • Wash your hands frequently with soap and warm water or use an alcohol-based hand sanitizer.
  • Cover your cough with a tissue or cough into your inner elbow and not into your hands.
  • If you are sick stay home from work and if your child is sick keep them home for 7 days, or 24 hours after your symptoms go away—whichever is longer.
  • Stay informed about the latest developments on the H1N1 flu, by visiting www.mass.gov/dph.

Me, my mom, my kid and breast cancer + health reform reality checks

(I think technically that should say “My mom, my kid and I” but “me” sounds better here. )

Kaiser Health News has a good roundup of stories this morning on the response to the anti-health reform Teabaggers. The NY Times refers to a new WH web page called “Health Insurance Reform Reality Check.”

 Also, will the La Leche League save me from breast cancer? My mom didn’t nurse but I did. She had BC in her 50s. Check out this Globe story on a BWH study but remember – with epidemiology studies like this one, there is no proof of cause and effect. In other words you can’t say breastfeeding reduces cancer risk in women with a family history of the disease. You can say that women with a family history who breast feed are less likely to get BC that those who do not, according to one study.  There may be something else about these women that lowers their risk, but this study SUGGESTS breast feeding had something to do with it. See this story on epi studies via the fab Association of Health Care Journalists.