The Ethics of Keeping Alfie Alive
By SAURABH JHA
Of my time arguing with doctors, 30 % is spent convincing British doctors that their American counterparts aren’t idiots, 30 % convincing American doctors that British doctors aren’t idiots, and 40 % convincing both that I’m not an idiot.
A British doctor once earnestly asked whether American physicians carry credit card reading machines inside their white coats. Myths about the NHS can be equally comical. British doctors don’t prostate every morning in deference to the NHS, like the citizens of Oceania sang to Big Brother in Orwell’s dystopia. Nor, in their daily rounds, do they calculate opportun...
Source: The Health Care Blog - May 21, 2018 Category: Consumer Health News Authors: at RogueRad Tags: OP-ED Uncategorized AlfieEvans Source Type: blogs
Are “Fatal” Opioid Concentrations Really Fatal?
When medical examiners conclude that the cause of death is opioid overdose, they rely primarily on the opioid blood concentration level in comparison to a pre-determined “fatal” cutoff. This approach is potentially inaccurate; the fatal ranges used are wide, and they overlap significantly with the ranges for living opioid users.Numerous fatal ranges have been quoted for methadone:220-3040 μg/L (mean, 1371),320-2980 μg/L (mean, 772), and600-3000 μg/L. Baselt’sDisposition of Toxic Drugs and Chemicals in Man found fatal levels of 400-1800 μg/L (mean, 1000) and 60-3100μg/L (mean, 280). These ranges are much too bro...
Source: Cato-at-liberty - May 14, 2018 Category: American Health Authors: Jeffrey Miron Source Type: blogs
Growth Rate of Spending on Medicine Slows
The IQVIA Institute for Human Data Science recently released a report focused on net spending on medicines in the United States in 2017, with an outlook to 2022. The report notes that spending on medicines grew less than one percent in 2017 – just a mere 0.6 percent.
The report further found that the level and growth of spending, the price of new and old drugs, and the allocation of costs among patients, employers, health plans, intermediaries, and state and federal agencies, all “command great attention,” and therefore, the report aims to provide an “objective measure of medicine use” and the cost prescriptions...
Source: Policy and Medicine - May 10, 2018 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Addressing the health care system flaws that feed the opioid crisis
I’m an ED physician, so I’m used to patients screaming at me — sometimes with earsplitting demands for heavy-duty painkillers, morphine drips and similar remedies that will numb or “fix” them. I can deal with this. What I can’t deal with is a health system that incentivizes physicians like me to medicate adult patients, especially those at high risk for substance abuse, with little thought given to their long-term wellbeing.
As I write this, a recent incident comes to mind: Earlier this year, a regular heroin user experiencing a medical crisis entered my ED. After going over his medical history, I tried to expr...
Source: Kevin, M.D. - Medical Weblog - May 8, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/anne-zink" rel="tag" > Anne Zink, MD < /a > Tags: Physician Emergency Medicine Pain Management Source Type: blogs
Primary care physicians are on the front line of the opioid epidemic. Help them.
When it comes to the opioid epidemic, physicians are some of the best drug dealers around with almost unrestricted access to the purest substances. As the opioid epidemic spirals out of control, physicians continue to be able to provide their patients with a variety of options, including oxycodone, morphine and fentanyl. Many people would be surprised to know that physicians don’t need any additional training to prescribe opiates to their patients especially considering that 40 percent of opioid deaths last year involved a prescription medication. But paradoxically, if physicians want to treat opioid addiction, they are ...
Source: Kevin, M.D. - Medical Weblog - May 1, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/arjun-gokhale-and-john-huston" rel="tag" > Arjun Gokhale, MD and John Huston, MD < /a > Tags: Conditions Pain Management Primary Care Source Type: blogs
Check Out The RWJF Opioid Challenge Semi-Finalists!
By JOHN EL-MARAGHY and CHANLY PHILOGENE
The opioid crisis has devastated countless families and individuals across the United States and abroad. What once started as a quiet concern has become a full-blown epidemic, requiring the full support and attention of the healthcare and tech communities to address it.
From the Surgeon General’s August 2016 letter on Opioid Addiction:
“I am asking for your help to solve an urgent health crisis facing America: the opioid epidemic. Everywhere I travel, I see communities devastated by opioid overdoses. I meet families too ashamed to seek treatment for addiction. And I will never f...
Source: The Health Care Blog - April 24, 2018 Category: Consumer Health News Authors: Matthew Holt Tags: Catalyst @ Health 2.0 Source Type: blogs
A 33 year old male with acute back pain radiating to the chest
Written by Pendell Meyers, with edits by Steve SmithCaseI was called to the EMS control room to answer an RMA (Refusal of Medical Advice). After the call was over, just before I was about to go back to the grind in our acute emergency department, my fantastic EMS colleague paramedic Jess Boyle asked me for an opinion on these 2 ECGs from a single patient, one done immediately after the other, without any other clinical information:What do you think?Both of the ECGs show sinus rhythm with normal QRS complex morphology. There is ST segment depression in leads III and aVF with inappropriate large " volume " T-wave inversion. ...
Source: Dr. Smith's ECG Blog - April 23, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
The Insys Net Gets Wider
In mid-March 2018, five New York City doctors were arrested and charged with accepting bribes and kickbacks from Insys Therapeutics to prescribe high volumes of Subsys, a fentanyl-based cancer pain medicated spray. The five doctors – Gordon Freedman, 57, of Mount Kisco; Jeffrey Goldstein, 48, of New Rochelle; Todd Schlifstein, 49, of Manhattan; Dialecti Voudouris, 47, of Long Island City and Alexandru Burducea, 41, of Little Neck – all practiced in Manhattan and pled not guilty in federal court to an unsealed indictment charging them with several charges, including conspiracy.
The five doctors allegedly collected tens...
Source: Policy and Medicine - April 19, 2018 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
CMS Proposes Changes to Part D and Medicare Advantage
Earlier this year, CMS proposed changes to the Medicare Advantage and Part D programs through the Advanced Notice and Draft Call Letter for 2019. This is important as Medicare Advantage enrollment grows each year. One-third of Medicare beneficiaries are now enrolled in Medicare Advantage Plans.
Proposed Policies
CMS notes that the proposed policies and updates for 2019 are intended to “remove barriers to innovation and foster greater transparency, flexibility, and program simplification.” CMS proposes an average rate increase of 1.84%, and factoring in plan coding practices CMS estimates a net payment increase of 4.9...
Source: Policy and Medicine - April 11, 2018 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Multiple Distinguished Health Care Practitioners Speak Out Against Misguided Opioid Policy
On March 30, Sally Satel, a psychiatrist specializing in substance abuse at Yale University School of Medicine, co-authored an article with addiction medicine specialist Stefan Kertesz of the University of Alabama Birmingham School of Medicinecondemning the plans of the Center for Medicare and Medicaid Services toplace limits on the amount of opioids Medicare patients can receive. The agency will decide in April if it will limit the number of opioids it will cover to 90 morphine milligram equivalents (MME) per day. Any opioids beyond that amount will not be paid for by Medicare. One year earlier, Dr. Kertesz made similar c...
Source: Cato-at-liberty - April 2, 2018 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
The Other Opioid Crisis: Hospital Shortages Lead To Patient Pain, Medical Error
I came across this public-accesss story, and wanted to share the perspective:
Pauline Bartolone, Kaiser Health News
Even as opioids flood American communities and fuel widespread addiction, hospitals are facing a dangerous shortage of the powerful painkillers needed by patients in acute pain, according to doctors, pharmacists and a coalition of health groups.
The shortage, though more significant in some places than others, has left many hospitals and surgical centers scrambling to find enough injectable morphine, Dilaudid and fentanyl — drugs given to patients undergoing surgery, fighting cancer or suffering traumatic i...
Source: Suboxone Talk Zone - March 26, 2018 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Acute Pain Anesthesia Public policy surgery Chronic pain opioid addiction Source Type: blogs
The Other Opioid Crisis: Hospital Shortages Lead To Patient Pain, Medical Error
I came across this public-accesss story, and wanted to share the perspective:
Pauline Bartolone, Kaiser Health News
Even as opioids flood American communities and fuel widespread addiction, hospitals are facing a dangerous shortage of the powerful painkillers needed by patients in acute pain, according to doctors, pharmacists and a coalition of health groups.
The shortage, though more significant in some places than others, has left many hospitals and surgical centers scrambling to find enough injectable morphine, Dilaudid and fentanyl — drugs given to patients undergoing surgery, fighting cancer or suffering traumatic i...
Source: Suboxone Talk Zone - March 26, 2018 Category: Addiction Authors: admin Tags: Acute Pain Anesthesia Public policy surgery Chronic pain opioid addiction Source Type: blogs
The Other Opioid Crisis: Hospital Shortages Lead To Patient Pain, Medical Error
I came across this public-accesss story, and wanted to share the perspective:
Pauline Bartolone, Kaiser Health News
Even as opioids flood American communities and fuel widespread addiction, hospitals are facing a dangerous shortage of the powerful painkillers needed by patients in acute pain, according to doctors, pharmacists and a coalition of health groups.
The shortage, though more significant in some places than others, has left many hospitals and surgical centers scrambling to find enough injectable morphine, Dilaudid and fentanyl — drugs given to patients undergoing surgery, fighting cancer or suffering traumatic i...
Source: Suboxone Talk Zone - March 26, 2018 Category: Addiction Authors: admin Tags: Acute Pain Anesthesia Public policy surgery Chronic pain opioid addiction Source Type: blogs
A Pre-death Rally or True Health Improvement: It ’s Difficult to Know
Dear Carol: My mom has had Multiple Sclerosis (MS) for 30 years and is nearing the end of her life. She lives in a nursing home and I visit daily. Mom’s been struggling to swallow and has been sick with a urinary tract infection (UTI). Sometimes she's even thought that my dad, who died two years ago, is with her. She was eating and drinking little and was anxious. Two days ago, the staff told me that this could be the beginning of the end, and the time for comfort care may be coming, but they wanted to try a different antibiotic, a sedative to calm her, and a small amount of morphine for pain before mak...
Source: Minding Our Elders - March 25, 2018 Category: Geriatrics Authors: Carol Bradley Bursack Source Type: blogs
Hospitalized Patients Are Civilian Casualties in the Government's War on Opioids
A recentstory by Pauline Bartolone in the Los Angeles Times draws attention to some under-reported civilian casualties in the government ’s war on opioids: hospitalized patients in severe pain, in need of painkillers. Hospitals across the country are facing shortages of injectable morphine, fentanyl, and Dilaudid (hydromorphone). As a result, trauma patients, post-surgical patients, and hospitalized cancer patients frequently go un dertreated for excruciating pain.Hospitals, including the ones in which I practice general surgery, are working hard to ameliorate the situation by asking medical staff to use prescription opi...
Source: Cato-at-liberty - March 18, 2018 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
