Joe and Teresa Graedon give lots of healthcare advice in their syndicated column, "The People's Pharmacy," and on their National Public Radio show by the same name. He's a pharmacologist, and she's a medical anthropologist. The Durham, NC, residents have written more than 14 books on topics from herbal remedies to deadly drug interactions. They should know how to get the best medical care. But in 1996, Joe's 92-year-old mother, Helen, died as the result of errors made at Duke Hospital. Joe Graedon thought he had been a good advocate. He stayed by his mother's bedside and repeatedly told her caregivers that she couldn't tolerate morphine and other narcotics. But in the end, he said, "You have to trust the doctor." He felt guilty about not being able to protect her. But soon that guilt turned to action. He and his wife reconstructed the steps leading to Helen Graedon's death, and that story opens their new book.
Fewer people in the U.S. report having angina or a heart attack, though the South continues to be a hot spot for heart troubles. So says the CDC in its latest Morbidity and Mortality Weekly Report. The percentage of adults surveyed who report being told by a health professional that they have coronary heart disease — which happens when the blood vessels to the heart narrow, causing chest pain or heart attack — fell to 6% last year from 6.7% in 2006. There's been a concerted public-health effort over the past two decades to better prevent and treat heart disease. Fewer people are smoking, and hypertension and high cholesterol are better controlled. As the WSJ's Ron Winslow has reported, the payoff has included a sharp drop in the heart-attack rate among older Americans. But cardiovascular disease is still the leading cause of death in the U.S. — according to the CDC, it kills more people than cancer, lower respiratory diseases and accidents combined. And according to the new stats, prevalence of CHD varies by age, gender and ethnicity.
Medical centers nationwide have been resorting to alternate routes as traditional providers and quantities of medicine have dried up. During the summer, just more than half of the 549 U.S. hospitals responding to a survey by the Institute for Safe Medication Practices, a patient safety group, said they had purchased one or more prescription drugs from so-called "gray market vendors"- companies other than their normal wholesalers. The U.S. Food and Drug Administration reports it is tackling the issue. "The FDA will continue its efforts to work with manufacturers to ameliorate shortages. For example, FDA already expedites requests to qualify new manufacturing sites, new production lines or new raw material suppliers to avert drug shortages," said FDA Commissioner Margaret Hamburg and Assistant Secretary for Health Howard Koh.
When patients leave the hospital, it doesn't mean they're cured. If they don't take their medicine, improve their diet or get check-ups, they can end up back in the hospital. More than any other hospital in the region, Barnes-Jewish Hospital in the Central West End struggles with high numbers of returning patients. The hospital needs to reduce the number of patients who were already in the hospital within the past month or face a loss of Medicare payments. A certain percentage of those readmissions are unavoidable. Other times, patients just need help filling their prescriptions or following through with discharge instructions. Or they come back to the emergency room because they have nowhere else to go. That's where the hospital's newly opened Stay Healthy Clinic comes in. Dr. Henish Bhansali runs the clinic, where he sees patients within a week of their release from Barnes. Patients who are identified during their hospital stay as vulnerable— they have a diagnosis of heart failure and their social situation puts them at risk to return—are given an appointment in the clinic within a week of their initial discharge. The hospital can arrange transportation and provide cab vouchers for the return visit.
Ever wonder who's behind the new recommendations for, say, how to treat high cholesterol or whether to screen men for prostate cancer? More specifically, do you ever wonder whether experts on the panels that develop guidelines have financial ties to pharma or device companies that might be affected? The Institute of Medicine recommends that ideally, guideline developers shouldn't have any financial investments in companies that stand to benefit from recommendations, nor should they (or family members) participate in marketing activities or advisory boards of those companies. Sometimes it's not possible to convene an entirely conflict-free panel, in which case members with financial ties to industry should be only a minority of the panel, the IOM says. Panel chairs or co-chairs should not have conflicts at all, and industry shouldn't have a role in developing the guidelines, the group says. Using that framework, researchers looked at 14 guidelines published by groups in the U.S. and Canada for screening or treatment of high cholesterol and diabetes. Of the 288 total panel members, 52% had conflicts of interest—138 declared, and 12 undeclared. (Some of those were undeclared because the panels were among the five that didn't require public disclosure.)
Eisenhower Medical Center has received its accreditation to become a full-fledged teaching hospital and expects to begin training doctors in 2013 to help fill the Coachella Valley's longstanding primary care shortages. "One hundred and two primary care physicians are needed to to close the gap," said Dr. Roy Young, director of the new internal medicine residency program—one of two the Rancho Mirage hospital will offer. "That becomes the mission of our residency program—to train people to stay here," Young said. Teaching hospitals also raise the level of care in a region, since both faculty and students must keep up with the latest medical research and technology, said Dr. Glen Grayman, president of the board of the Health Assessment Resource Center. The group surveys healthcare needs in the valley. More doctors also will keep health care dollars in the valley, he said. "Each of their practices is an economic engine not only supporting their own staff but supporting the hospitals, supporting labs, supporting imaging centers and that money stays here," Grayman said. It'll cost $50 million to start the residency programs.