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Alternative Medicine's Rapid Spread? Nonsense
Tweet Share on Facebook December 12, 2008 Comment (27)I don't want to provoke the ire of the pros or the antis (I managed to anger both after doing a story about alternative medicine in January), so please heed: This post is not about the clincial merits of herbals, acupuncture, homeopathy, and other forms of complementary and alternative medicine. It's about the intellectual dishonesty of the surveys that appear every few years purporting to show CAM use. Invariably, very, very large numbers of Americans say they use CAM, and this year's report is no exception. Released earlier this week by the National Center for Complementary and Alternative Medicine (part of the National Institutes of Health) and the National Center for Health Statistics, it shows that almost 40 percent of all American adults used some form of CAM in 2007.
Spin, folks. The kind that would do a political consultant proud. It started almost 20 years ago with the first large survey in 1990. That one found 34 percent of U.S. adults used alternative medicine (as it was then called). "Used" was defined so generously, however, that it's hard to understand how almost every person surveyed didn't qualify. You were a user if one time in the previous year you used one of the 16 listed therapies, which included such marginal entries as "self-help group," "commercial diet," and "lifestyle diet." The 1997 survey was the same except more so; usage was up to 42 percent.
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For Better CT Scan Readings, Add Patient’s Photo
Tweet Share on Facebook December 2, 2008 Comment (1)If the study I read this morning holds up, maybe you and I and everybody else should start carrying a wallet-sized photo of ourselves. Make it one that's cute or fun or expressive. Maybe call attention to it with a big bright smiley on the front. And attach this note: IF YOU ARE READING THIS IN THE EMERGENCY ROOM AND I AM GETTING A CT SCAN, PLEASE PLEASE PLEASE GIVE MY PICTURE TO THE RADIOLOGIST.
Why? Because when faces of patients who got a diagnostic CT scan were put on the screen along with the CT images, radiologists did a more thorough job of interpreting the results. The study, presented today at the radiologists' annual scrum, hosted in Chicago by the Radiological Society of North America, was small, but its findings were clear, significant, and either intriguing or scary, depending whether you're Pollyannaish or a skeptical reporter. My reaction was alarm at what is now being missed rather than elation at the additional information that might be unearthed.
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Is Robotic Surgery Better? Or Just Marketing?
Tweet Share on Facebook November 25, 2008 Comment (2)Why the U.S. healthcare system (if you want to call it a system, which it isn't) is a mess is obvious. It's mostly because of bureaucratic, inefficient, denial-fixated health insurers—chop out the waste, and escalating costs will come back into line. Considering this albatross as well as various other handicaps, it's amazing that the quality of our healthcare is really good.
Myths, both. Administrative expenses are a relatively small driver of healthcare costs. And the quality of U.S. care not only fails in many respects to measure up to the care delivered in other countries but swings between extremes depending on where you live, the caregiver you see, and the hospital you use. Shannon Brownlee, a visiting scholar at the National Institutes of Health Clinical Center (and a former U.S. News colleague), and oncologist Ezekiel Emanuel, chairman of the center's bioethics department, busted those two myths and three other widespread misconceptions in a well-argued piece in Sunday's Washington Post that is well worth reading.
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Medical Tourism to India, All Expenses Paid
Tweet Share on Facebook November 21, 2008 Comment (15)Lots of talk, not much action—until now. In January, Serigraph Inc., a West Bend, Wis., manufacturer, will become the first U.S. company of any size to embrace medical travel or medical tourism, offering employees the option of having certain nonemergency operations, such as joint replacement, in India. The company will pay all expenses, including travel and lodging for a companion. The incentive for employees is that they don't have to pay a deductible—typically $1,000 to $5,000—or the hospital copay, which would be 10 percent to 20 percent of the charges.
Last May, I went to India and Singapore to explore the trend of growing numbers of under- and uninsured Americans heading to both places and other foreign climes to take advantage of package prices for hip replacement, heart valve repair, spinal surgery, and other elective procedures that can be 80 percent less than the sums charged by U.S. hospitals. To cite one expensive example, heart bypass surgery can easily run up a $70,000 to $133,000 bill at a U.S. center, compared with an average of $7,000 at Indian hospitals catering to westerners. An uninsured patient I interviewed extensively in India paid a total of about $25,000 to have both hips and one knee replaced, including airfare and incidentals. He easily could have paid more than $125,000 at a U.S. hospital. And there are plenty of similar cases of huge price differences.
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Are Hospital Ratings a Mess, a Message, or Both?
Tweet Share on Facebook November 18, 2008 Comment (5)Last Friday, I criticized a report in the public policy journal Health Affairs arguing that consumers' relatively restrained use of hospital ratings and data (such as America's Best Hospitals) can be blamed on confusion: The ratings and rankings measure different aspects of care, cannot be compared, and often contradict each other. I wrote that consumers can wade through the information, just as families sift through facts and numbers in America's Best Colleges and other college guides of more than 1,500 pages and cobble together custom lists online by sorting and clicking. I charged the study authors with underestimating consumers and condescending to their capabilities to do the same with hospital data.
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U.S. News's 'Best Hospitals' Clashes With Other Ratings. Is That Bad?
Tweet Share on Facebook November 14, 2008 Comment (5)U.S. News, publisher of the annual "Americas Best Hospitals" rankings, isn't the only hospital-rating game in town. Corporate-backed groups such as Leapfrog and the federal government's Medicare arm, through its Hospital Compare page on the Web, are other examples of public reporting of hospital data and ratings, each with its own unique approach. A new study in Health Affairs , a public-policy journal, concludes that because the ratings measure different qualities and disagree with one another, consumers are confused rather than enlightened. As Health Affairs puts it, sometimes more is less.
I see the point, but I think motivated consumers—as I would call anyone looking for information about particular hospitals—can sort things out better and be smarter than the authors seem to believe they can. And the pot of gold the authors are seeking at rainbow's end—broad-based information that is useful, accurate, and consistent across different reporting platforms—is wishful, almost delusional thinking. Developing a consensus among clinicians, analysts of data quality, and occupants of hospital executive suites about how to define, collect, measure, and report data that is meaningful is far more difficult than herding cats or whatever comparison you want to make.
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A Preop Shower to Cut Infections
Tweet Share on Facebook November 11, 2008 CommentLast week, a large part of the U.S. News staff busily churned out election coverage while a much smaller team—a couple of Webbies, as we affectionately call our online producers and programmers, plus a data specialist and I—raced to finish up the 2008-09 Best Health Plans rankings. Everything else, including this blog, had to wait at the crossing for the Best Plans train to pass, as all good things eventually must. Now that it has, I need to do a little catching up.
For today, I'll call your attention to "Rub a Dub Dub," a recent blog post in Aggravated DocSurg about showering before an operation. That's what it starts out as, anyway. The blogger is a general surgeon with an attitude, as the blog's name suggests, but the right kind—one of his pastimes is sniffing out claims and studies whose underpinnings are shakier than they seem. He's an informed skeptic. ("Experience is the name everyone gives to their mistakes," an Oscar Wildeism, is one of several quirky quotes at the top.)
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Even Doctors Misread Health Statistics
Tweet Share on Facebook October 14, 2008 Comment (2)Like people generally, most patients are not statistics whizzes, but we rightly expect physicians to understand and to be able to place in perspective any numbers that reflect on their patients' health and medical decisions. A distressing report in the journal Psychological Science in the Public Interest argues persuasively that many doctors simply don't, and that anxious patients who make bad healthcare decisions are among the consequences.
An example drawn from the report: a woman who has had a routine mammogram and is told the result is positive. "What does that mean?" she asks her physician. "What are the chances that I have breast cancer?" Her emotional reaction to a high percentage will surely be different than to a low one. In a study of women who had received a false positive on a mammogram, 1 in 8 said the anxiety it created affected their mood and ability to function months later.
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An Outbreak of Hospital Infection Talk
Tweet Share on Facebook October 7, 2008 Comment (10)I'll be curious to hear about the weapons that will be rolled out tomorrow at a press conference on combating healthcare-acquired infections. It has been billed as a first-ever event, with five leading healthcare organizations linking hands to announce a unified approach to reduce, ideally wipe out, infections in healthcare facilities. The five groups—the American Hospital Association, Association for Professionals in Infection Control and Epidemiology, Infectious Diseases Society of America, Joint Commission, and Society for Healthcare Epidemiology of America—have undeniable clout.
But how much of an answer can institutional muscle provide, really? Many of the tactics that will defeat HAIs are well known and at least in theory not difficult to put into practice. Everyone who walks into a patient room—that includes family and friends as well as caregivers—can and should faithfully sanitize his hands. Insertion and maintenance of central venous line catheters can and should follow established procedures, called a central line bundle, that minimize the chance of infection. Antibiotics can and should be administered before and after surgery based on timing that both reduces the possibility the surgical wound will become infected and minimizes the growth of antibiotic-resistant bacteria. I could go on.
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Now Hospitals Must Pay for Avoidable Complications
Tweet Share on Facebook September 30, 2008 Comment (11)Years in the making, a new Medicare rule that takes effect at midnight tonight should make hospital care a little safer. Here's how: If the cost of treating a Medicare patient is pushed up because one of a defined set of avoidable problems happened on the hospital's watch—such as a fall, bedsore, or urinary tract infection that occurred or arose after the patient was admitted—the Centers for Medicare and Medicaid Services will no longer reimburse the hospital for the additional expense. The incident will be considered a hospital-acquired condition, not a complication that up to now would have triggered a higher payment. (I described all this in detail in August of last year, when the rule was issued.)
Not only does this make sense—why should public funds be spent to prop up substandard hospital care?—but a very tangible financial incentive now exists for hospitals to do everything they can to avoid these events, which can bulk up expenses by tens or even hundreds of thousands of dollars. Some of the conditions on the CMS list are relatively rare, like the 24 instances last year of mismatched blood transfusions, but others are all too frequent, such as the 257,412 cases of advanced bedsores and 12,185 urinary tract infections in catheterized patients. (A major cause of these UTIs is that catheters are left in place too long, and one reason for this is that they are buried under the covers, so nurses and doctors can forget that they are there.)
Comarow On Quality
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.
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