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A Dose of Lead or Mercury With Your Medicine
Tweet Share on Facebook August 27, 2008 Comment (5)Are we being pummeled with so many warnings about heavy metals in the food and water that we're starting to tune out? Not all of the media reports about a new study that found heavy metals such as lead and mercury in a sizable sample of traditional ayurvedic medicines of India have been as cautionary (a polite word for alarming) as I would have liked them to be. I'm not a physician or toxicologist or biochemist, but I've written about alternative medicine and read a few studies over the years, and the bottom line of this one, in the latest issue of the Journal of the American Medical Association, is about as subtle as a traffic cop's whistle.
Here it is: Out of 193 ayurvedic medicines purchased online—115 of them manufactured in the United States, 77 in India, and 1 in Canada—about 1 in 5 contained detectable amounts of lead, mercury, and arsenic. While some reporting has noted that the incidence was higher among U.S.-made products, the difference is trivial, 21.7 percent compared with 19.5 percent of medicines from India.
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If Medicine Is So High-Tech, Why So Much Illness?
Tweet Share on Facebook August 26, 2008 Comment (5)"Early in my ER career I decided I would not press my medical opinions on people who did not request them," writes Robert Martensen in the quietly compelling A Life Worth Living: A Doctor's Reflection on Illness in a High-Tech Era, which will be published next month. Being closemouthed isn't easy for physicians, drilled from the start of their training to absorb, recall, and recite information. The context in the book is a 40-year-old patient named Marguerite. Martensen had tentatively diagnosed inflammatory breast cancer in Marguerite, who had asked to come to his ER because she knew him casually and she wanted him, not an unfamiliar doctor, to check out a tender spot in one breast. His diagnosis subsequently was confirmed, and she was about to enter the hospital for a bilateral mastectomy. "We're going to lick this thing!" her husband, Eduardo, told Martensen.
"I wanted to say and ask many things, but I did not," writes Martensen, who was no longer involved in Marguerite's care. "My job, if I had one, involved being supportive.... To do otherwise, I told myself, to attempt to insert myself into their intimate life, would be disrespectful. The last thing they needed was for me or any outsider to sow doubt."
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The Wild West of Medical Care Abroad
Tweet Share on Facebook August 22, 2008 Comment (16)Take a quick look at these two emblems. Displayed online, both are supposed to convey trustworthiness to patients considering a trip to another country for medical care. Do they look similar?
The sources of the seals are very different. The seal on the right is from the Joint Commission International (JCI), which accredits hospitals abroad for safety and quality. It's an arm of the Joint Commission, which is tasked by Congress with accrediting U.S. hospitals. The other is from the Medical Tourism Association (MTA) a trade group based in West Palm Beach, Fla. Its members include foreign hospitals, health insurers, and "facilitators," a specialized category of travel agencies that arrange and book medical trips abroad.
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Hospital Deaths Go Public
Tweet Share on Facebook August 21, 2008 Comment (4)How well thousands of individual U.S. hospitals do on the ultimate test of hospital competence—whether very sick patients live or die—is now revealed on the Web for all to see, in hard numbers. The Hospital Compare page maintained by the Centers for Medicare & Medicaid Services (CMS) this week began displaying actual hospital death rates for heart attack, heart failure, and pneumonia patients. Until now, only relative performance had been shown—whether mortality for such patients at a particular hospital was about the same as the national average, better than average, or worse than average.
This is a big step forward. The death rates, says Harlan Krumholz, director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital, which developed the mortality measure, "provide insights into where hospitals are compared to where they should be."
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How Involved Should Patients Be?
Tweet Share on Facebook August 5, 2008 Comment (3)"Patient-centered care," which stripped of all its fuzziness I take to mean that patients should be equal partners (or more) with the physicians who treat them, is a current hot topic in healthcare. At its heart lies a fundamental and fascinating question: Are patients the best judges of their own care? Hospitalist Robert Wachter's current discussion of patient-centered care on his blog, Wachter's World, is long, but it's a great read, touching on almost everything that makes me a little uncomfortable with the concept.
Wachter sets out generally agreed-upon principles of patient-centered care: Patients' preferences should be respected; caregivers should attend to patients' emotional needs—their context, comfort, and significance; patients should be engaged and empowered; there should be shared decision making that promotes patient autonomy; family and friends should be involved in care decisions where appropriate; and care should be coordinated within and across systems. As Wachter says, well, sure.
U.S. News's Avery Comarow has been editor of the America's Best Hospitals annual rankings since they first appeared in 1990. His reporting on clinical medicine, from the latest cholesterol guidelines to robotic surgery, has been driven by the question: What does this mean to patients? And that is the perspective he brings to his observations and commentaries on the increasing number of programs by hospitals and other healthcare providers to improve care and patient safety.
