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Campaign seeks to curb sharp rise in syphilis cases in Seattle and King County

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In response to an explosion of new cases of syphilis, health officials here have launched a media campaign to encourage gay and bisexual men to get tested for the sexually transmitted infection.

In the 1990s, the infection, which is caused by the bacteria Treponema pallidum, had almost been eliminated among gay and bisexual men in the county, but cases have soared recently, nearly doubling from 2009 to 2010, to 289 cases, and this year the number of cases is on track to double yet again.

Number of cases of early syphilis in King County, WA, by year and sexual orientation, 1994-2010

Gay and bisexual men–men who have sex with men or MSM– account for 90 percent of the new cases, according to Public Health – Seattle & King County, the campaign’s sponsor.

The new campaign, called “Syphilis is Back”, emphasizes that syphilis is easy to catch — but also easy to treat.

Syphilis is usually spread when a person comes into contact with syphilis sore, called a chancre, during vaginal, oral and anal sex. Because these sores can be hidden from view, it is often impossible to tell if a sex partner is infected.

In addition, the symptoms of syphilis can be easy to miss. The first symptom is a chancre, a raised, painless sore, which usually goes away in a few weeks.

Treponema pallidum -- CDC Photo

But even though the sore has gone, the infection persists and with time can have devastating effects on the heart, brain and other organs. Untreated infection in pregnant women can also have devastating effects on the fetus.

However, early infections can be easily treated with a single antibiotic injection.

The new campaign encourages sexually active gay and bisexual men to get tested for syphilis regularly and if they have any symptoms of the infection to be tested right away.

To learn more about the campaign, the signs and symptoms of syphilis, and local testing sites:

  • Go to Public Health – Seattle & King County Sexually Transmitted Diseases webpage which has additional information about STDs and information about testing sites.
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Seattle Children's Whale Logo

Children’s moves to improve care of patients in transport — Seattle Times

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In response to an investigation by the U.S. Centers for Medicare & Medicaid Services, Seattle Children’s has taken steps to improve how it provide care to patients while they are bring transported overland, Seattle Times health reporter Carol Ostrom reports in today’s paper.

Ostrom writes:

The CMS report, triggered by a state finding of deficiencies in hospital procedures, said transport nurses appeared to be confused about what they were allowed to do and whether they could administer medications without a doctor’s order. It said the hospital’s review of the cases didn’t pick up that documentation was inaccurate and incomplete or that doctors’ orders — required by law — were missing.

“CMS has accepted the hospital’s plans to correct the deficiencies in the quality improvement process and others noted in that survey, as well as for additional problems cited in a more wide-ranging follow-up survey done in March,” Ostrom reports.

To learn more:

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Jane's expenses on a balance beam with what her plan will pay.

New labels will soon making picking a health plan easier

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By Susan Jaffe

Cars have sticker prices, ketchup bottles have nutrition facts labels and soon health plans will get coverage labels, too.

For the first time, consumers shopping for a health policy will be able to get a good idea of how much of the costs different plans will cover for three medical conditions: maternity care, treatment for diabetes and breast cancer.

And because buying insurance is more complicated than buying a can of soup, the proposed insurance labels are two pages long.

However, the labels will provide pricing based on national averages and not exact numbers that consumers can expect to pay.  And to begin with, only the three medical scenarios will be listed.

“It’s nearly impossible for a consumer to make apple-to-apple comparisons.  It’s the Wild West.”

“Today, there’s really no way for consumers to figure what their premiums are buying,” said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute in Washington, D.C., who is helping to produce the labels.

The true value of a plan depends on what health problems a beneficiary experiences, but in most cases consumers shopping for plans have no way to compare how much of the costs of treatment the policies will cover. “It’s nearly impossible for a consumer to make apple-to-apple comparisons.  It’s the Wild West,” she said.

The new “coverage facts labels” are required under the health overhaul law, which directed the National Association of Insurance Commissioners to draft them. The association gave that job to a working group made up of state insurance regulators, industry representatives and consumer advocates.

On Thursday, the group agreed to seek public comment on the draft labels and conduct consumer focus testing for additional feedback before presenting them to state insurance commissioners.

Once approved, the labels will be sent to federal officials who will consider incorporating them into rules for insurance companies. The labels are part of an effort to demystify insurance terminology and costs so that consumers can better understand what they are purchasing.

The law also requires that consumers receive new, easy-to-understand summary of plan benefits for consumer comparisons. The coverage labels are to be included at the end of the four-page benefits summary.

The federal rules, which were due last March, would instruct insurers to use benefit summaries and labels and are supposed to take effect next year. But developing the model format and language has proved to be complicated and taken more time.

“We want there to be as much information in the hands of consumers as possible,” said Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry group that will be conducting consumer focus group testing, as is Consumers Union, later this month. “But we want to make sure that the information is valuable from their perspective.”

Because medical costs vary widely across the country and among providers, and the treatment regimen may also depend on individual providers, the working group opted to use national average prices for the standard treatment regimen on the labels.  The labels then break down how a policy would apportion those costs.

For the breast cancer example, insurers will have to list how much patients would pay – based on the national average price—for office visits, lab tests, surgery, chemotherapy, radiation treatment, prosthesis (wig), prescription drugs and mental health counseling.  If a plan offers no maternity coverage, the label will show that the patient is responsible for paying the entire cost.

At first the working group was going to recommend that each health plan use prices based on their own provider contracts, said Richard Dropski, a group member and senior director for regulatory affairs at Neighborhood Health Plan in Massachusetts.  That turned out to be unwieldy: even within the same plan, two nearby hospitals can charge different prices for the same procedure, he said.

A 2009 study of three California insurance policies found that patients would spend nearly $4,000 for a standard breast cancer treatment under one policy or as much as $38,000 under another even though both policies had similar deductibles and out-of-pocket limits.

The actual costs at a specific hospital may be different from the amounts listed on the coverage label, said Mila Kofman, co-chair of the working group and Maine’s superintendent of insurance. “But you will be able to look at the label and look at two different policies and figure out if you’re a diabetic or if you have baby, under which policy it is likely that more of your costs will be covered,” she said.

The law requires that all carriers selling group or individual health plans provide the benefits summaries and the three treatment labels to shoppers beginning in March 2012.  There is no limit to the number of treatment coverage labels that may eventually be used.

Contact Susan Jaffe at jaffe.khn@gmail.com.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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EKG tracing

Financial ties bind medical societies to drug and device makers

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by Charles Ornstein and Tracy Weber
ProPublica, May 5, 2011, 9:48 p.m.

SAN FRANCISCO — From the time they arrived to the moment they laid their heads on hotel pillows, the thousands of cardiologists attending this week’s Heart Rhythm Society conference have been bombarded with pitches for drugs and medical devices.

St. Jude Medical adorns every hotel key card. Medtronic ads are splashed on buses, banners and the stairs underfoot. Logos splay across shuttle bus headrests, carpets and cellphone-charging stations.

At night, a drug firm gets the last word: A promo for the heart drug Multaq stood on each doctor’s nightstand Wednesday.

Who arranged this commercial barrage? The society itself, which sold access to its members and their purchasing power.

Last year’s four-day event brought in more than $5 million, including money for exhibit booths the size of mansions and company-sponsored events. This year, there are even more “promotional opportunities,” as the society describes them.

Concerns about the influence of industry money have prompted universities such as Stanford and the University of Colorado-Denver to ban drug sales representatives from the halls of their hospitals and bar doctors from paid promotional speaking.

Yet, one area of medicine still welcomes the largesse: societies that represent specialists. It’s a relationship largely hidden from public view, said David Rothman, who studies conflicts of interest in medicine as director of the Center on Medicine as a Profession at Columbia University.

See also: The Heart Rhythm Society Responds to ProPublica’s Questions — below

Professional groups such as the Heart Rhythm Society are a logical target for the makers of drugs and medical devices. They set national guidelines for patient treatments, lobby Congress about Medicare reimbursement issues, research funding and disease awareness, and are important sources of treatment information for the public.

Dozens of such groups nationwide encompass every medical specialty from orthopedics to hypertension.

“What you’re exploring here is the subtle ways in which the companies and professional societies become partners and — wittingly or unwittingly — physicians become agents on behalf of the interests of the sponsoring company,” said Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic.

“It has a not very subtle effect on medicine,” said Nissen, an expert on the impact of industry money.

‘This is our business’

Nearly half the $16 million the heart society collected in 2010 came from makers of drugs, catheters and defibrillators used to control abnormal heart rhythms, the group’s website disclosed.

Officials of the Heart Rhythm Society say industry money does not buy influence and is essential to developing new treatments. Still, on Thursday the group unveiled a formal policy that, among other things, requires more detailed disclosure of board members’ industry ties.

“This is our business,” said Dr. Bruce Wilkoff, the incoming society president. “We either get out of the business or we manage these relationships. That’s what we’ve chosen to do.”

The society is one of a handful of groups that make public details about their finances. Most don’t. As non-profits, they must disclose their tax returns but not their specific sources of funding.

Sen. Charles Grassley, R-Iowa, requested the information from the Heart Rhythm Society and 32 other professional associations and groups that promote disease awareness and research.

Their responses and reporting by ProPublica showed wide disparities in money the groups accept from medical companies, what they disclose and how they manage potential conflicts of interest.

With billions of dollars at stake, companies can court entire specialties by helping to bankroll doctors’ groups. The Heart Rhythm Society’s 5,100 members represent a particularly lucrative market.

One implantable cardioverter defibrillator — a device that jolts the heart back to a normal beat — can cost more than $30,000. A single electrophysiologist, a physician specializing in heart-rhythm disorders, can implant dozens a year. World sales of the devices totaled $6.7 billion last year, according to JPMorgan.

All the defibrillator manufacturers are at this week’s conference, including market leaders Medtronic, Boston Scientific and St. Jude Medical, which together gave the society $4 million last year.

These companies and others not only provided financial support to Heart Rhythm but paid many of its board members: Twelve of 18 directors are paid speakers or consultants for the companies, one holds stock, and the outgoing president disclosed research ties, according to the society’s website, which does not specify how much they receive.

Board members at other medical societies have similar arrangements. The American Society of Hypertension does not post disclosures on its website, but records provided to Grassley show that 12 of its 14 board members had financial ties to medical companies.

Grassley, the top Republican on the Senate Judiciary Committee, said these groups commonly say the money doesn’t affect what they do, but he has doubts. “I don’t think it’s believable,” he said. “There are a lot of incestuous relationships that really bother me.”

Big Booths Boost Devices

As competition among cardiac-device makers has intensified, so have questions about whether their products are being used and marketed appropriately.

In January, a study in the Journal of American Medical Association found that more than one in five patients who received cardiac defibrillators did not meet science-based criteria for getting them.

Weeks later, the Heart Rhythm Society disclosed it was assisting a U.S. Justice Department investigation of the issue.

Two of the society’s biggest funders — Boston Scientific and St. Jude Medical — have paid millions since 2009 to settle federal allegations that they improperly paid kickbacks to unidentified physicians to use their cardiac devices. Neither company admitted wrongdoing.

Top sponsor Medtronic also has disclosed to shareholders that the Department of Justice is investigating the advice it gave purchasers on how to bill Medicare for defibrillators and payments it made to buyers of the devices.

In a statement, Medtronic said societies play an important role in educating physicians about their devices. Boston Scientific declined to comment, and St. Jude did not respond to questions.

At this week’s conference, Medtronic is front and center with a 12,000-square-foot booth to demonstrate its products and allow physicians to examine them.

Medtronic spent $543,000 at last year’s meeting on a similar exhibit, part of $1.6 million it paid to prominently display its name around the conference and fund educational grants. The Minnesota device maker also paid unspecified speaking or consulting fees to eight of the society’s 18 board members.

Labeling the HRS Convention

These slides show “promotional opportunities” – and their asking price – that the Heart Rhythm Society offered to medical industry sponsors at its 2011 conference. Not everything was sold.
Sourcewww.heartrhythmsupport.org/sponsorships.

The spending befits the company’s dominance of the world market for implantable defibrillators. It sold more than $3 billion worth last year.

Next booth down is the 8,100-square-foot spread of rival Boston Scientific, with $1.6 billion in defibrillator sales last year. The company spent $1.5 million on the society in 2010 and paid speaking or consulting fees to seven board members.

Physicians must traverse these and other booths to reach “Poster Town,” where the latest research findings, a big draw of the gathering, are displayed. “It’s very hard to get through there without being accosted,” said Dr. Paul D. Varosy, director of cardiac electrophysiology at the Department of Veterans Affairs’ Eastern Colorado Health Care System.

‘Tag and Release’

Through the years, groups such as the Heart Rhythm Society have expanded the range of sponsorships they offer to drug and device makers. Companies can now fund Wii game rooms or put their names on conference massage stations and on the shirts of the masseuses.

Some deals give companies more than name exposure. Last month, the American College of Cardiology attached tracking devices to doctors’ conference ID badges. Many physicians were unaware that exhibitors had paid to receive real-time data about who visited their booths, including names, job titles and how much time they spent.

Dr. Westby Fisher, an Evanston, Ill., electrophysiologist, called the practice “Tag and release.” College officials say they’ll do a better job of notifying doctors next year.

Attendees at the Rhythm Society conference also have tracking badges. Society officials say exhibitors are not getting doctors’ personal information.

Two years ago, the American Society of Hypertension teamed with its biggest donor, Daiichi Sankyo, to create a training program for drug company sales reps. The society says about 1,200 Daiichi reps have graduated — at a cost of $1,990 each — allowing them to put the “ASH Accreditation symbol” on business cards.

In fiscal 2009, Daiichi gave the society more than $3.3 million — more than 70% of its total industry funding — according to financial records it provided Grassley. Daiichi makes four hypertension drugs.

“I think it’s an obscenity,” said former ASH president Michael Alderman, professor emeritus at Albert Einstein College of Medicine in New York City. “I can see how it would play out in the doctor’s office: ‘I’m a Daiichi sales rep. But let me tell you something: The American Society of Hypertension is backing me.’”

Alderman and some other prominent members of the group quit after a dispute in 2006 about industry influence.

Current ASH President George Bakris said the training program is science-based and doesn’t focus on specific drugs. The reps “ought to know what they are talking about,” he said.

The 1,900-member group has revised its policies since 2006, he said. Financial conflicts disclosed by board members, however, are available only to members, who must request them in writing and explain why they want them, according to the group’s conflict of interest policy.

Click Here to See How the Heart Society Sells Access

A Question of Influence

Bakris and leaders of several other professional groups say industry funding is essential for much of what they do. It reduces conference registration fees, subsidizes the cost of continuing medical education courses and provides money for disease awareness.

Dr. Jack Lewin, chief executive of the American College of Cardiology, said the money is helping build registries of cardiac procedures that track side effects and flag whether physicians are using devices in the right patients.

The “circus element” of the exhibit booths doesn’t unduly influence attendees, Lewin said. “I don’t buy a soft drink just because of the advertising… I buy it because I like it.”

Researchers say companies are not spending millions solely for altruistic reasons. “If it weren’t influencing the doctors, they wouldn’t be doing it,” said Dr. Gordon Guyatt, a health policy expert at McMaster University in Ontario.

There are fledgling efforts to push medical societies toward stricter limits on industry funding: 34 groups have signed a voluntary code of conduct calling for public disclosure of funding and limits on how many people on guideline-writing panels have industry ties.

“The general feeling is that the societies need to be independent of the influence of companies,” said Dr. Norman B. Kahn Jr., chief executive of the Council of Medical Specialty Societies, which helped draft the code.

Grassley, too, is continuing his efforts to make the groups publicly accountable. In initial responses to his December 2009 request for information, some said they planned to post financial information on their websites. This week, the senator followed up with letters to some groups, asking why they hadn’t done so.

He hopes the political pressure succeeds: “You might conclude that maybe they don’t want to give the information out because it might be embarrassing.”

Follow on Twitter: @charlesornstein@tracyweber

Read a related stories on the ProPublica website: Heart Society’s Tip Sheets Fail To Mention Risks.

The Heart Rhythm Society Responds to ProPublica’s Questions

Reporters Charles Ornstein and Tracy Weber sent the Heart Rhythm Society a set of questions about potential conflicts of interest regarding the group’s acceptance of drug and device industry marketing money. The responses below were provided by the group’s president, Dr. Douglas L. Packer, and president-elect, Dr. Bruce L. Wilkoff.

Q. What is the Heart Rhythm Society’sphilosophy with respect to accepting industry funding?

A. Advances in electrophysiology depend on a collaborative relationship between physicians and industry, who have for decades worked together to develop life-saving devices. The society collaborates with clinicians, scientists, allied professionals, government agencies, other societies and industry to advance electrophysiology/pacing and to accomplish its mission to improve the care of patients by promoting research, education and supportive resources for patients and their families.

The HRS is proactive in examining our policies and procedures on an ongoing basis to avoid conflicts of interest, the potential for misunderstandings or perceptions of bias.

Q. Figures in the financial report on your websiteindicate that half of HRS funding comes from industry sources. That proportion has gone up considerably from 2006. Do you believe the current figure is too low, too high or about right? Please explain.

A. Due to the current policies and procedures we have in place to manage collaborations with industry, the Heart Rhythm Society is seeking new more diverse revenue streams that support our mission. It is important to note that the society has received funding that has helped the public understand heart rhythm disorders through awareness initiatives such as the Apples and Oranges: Sudden Cardiac Arrest Awareness Campaign, which helped to raise government and public awareness of this deadly disease in order to save lives.

Q. Items at your conference—from key cards to newspaper wraps—are available for sponsorships. What is the purpose of these sponsorships? Does the livelihood of the organization depend on them? Do the ads have an impact on what your members buy and use in their practices?

A. The Heart Rhythm Society offers sponsorship opportunities at the annual scientific sessions to provide advertising opportunities for participating exhibitors. Approximately 50 percent of the revenue for the annual scientific sessions is generated by industry in a combination of exhibit space rental (largest), sponsorship/promotional advertising opportunities, unrestricted educational grants and exhibitor office suites. The society does not collect data or ask attendees if sponsorship or advertising impacts their purchase decisions.

Q. Four funders—MedtronicBoston ScientificSt. Jude and Sanofi—account for 30 percent of the group’s annual budget. Is this reliance on a small group cause for concern? Why or why not?

A. Due to thorough policies and procedures in place for working with industry, the Heart Rhythm Society is comfortable identifying and managing various interactions with industry. Additionally, the society seeks multiple supporters for its educational programs in order to avoid the perception that programs are tied to a specific company. The society has sufficient measures in place to prevent undue influence from industry or introduction of industry bias into HRS-sponsored educational programs, research, scientific documents and policy initiatives.

Q. Sixteen of your 18 board members had relationships with one or more drug or device manufacturers in 2010-11. Are these relationships cause for concern? Why or why not?

A. The Heart Rhythm Society strives to be a transparent entity. HRS leaders are required to disclose their relevant financial, commercial, professional and institutional relationships. Additionally, the society also places restrictions on its president and president-elect, who are prohibited from receiving income from commercial entities that have the potential for conflict of interest during the year(s) in which they hold the position. As charged by its Ethics Committee, the society reviews all disclosures and rules for interactions with industry on an annual basis. We make updates to our policies and procedures as needed.

Q. Most of the experts you appointed to your 2008 device guideline committee had conflicts, including the chair of the panel. Other groups, including the American College of Cardiology, are changing that balance. Will HRS do so as well? Why or why not? What are the potential problems to having guideline writers with conflicts?

A. The Heart Rhythm Society requires that at least one of the chairs of a clinical guidance writing group not have any relationships with industry that would apply to the document.

This policy takes into consideration that relationships with industry do not necessarily bias opinions or recommendations and that experts in the field should not be restricted from full participation in a writing group provided they recuse themselves if there is a conflict of interest. The priority on selection of authors is based on level of expertise, judgment and writing ability.

Q. Some doctors have criticized HRS and ACC for the afibprofessional.org website because they say it promoted Multaq even though the drug has turned out to have serious limitations. Do you believe this is an appropriate criticism? Why weren’t the industry ties of the editor and lecturer initially disclosed on the site? Should industry funding be accepted for non-CME educational material?

A. Afibprofessional.org is a non-CME professional site funded by nonrestricted grants from multiple sponsors. Similar to a journal publication, the site is overseen by an editorial board headed by Dr. Kenneth Ellenbogen. As editor, Dr. Ellenbogen is required to not have any conflicts of interests in companies that contribute to the site. The editorial board has complete control and oversight on how the monies are used and what content will be posted. Industry does not have any review or input into the content of programs.

The Heart Rhythm Society was concerned about the criticisms that were raised and carefully evaluated the circumstances that led to these concerns. The initial complaints about the website were in part due to a production flaw that did not hold the launch of the site until all the content was completed and educational commentary added to ensure balance. The site was updated and all disclosures linked within 72 hours of initial launch. Moreover, the lecturer you note, Dr. Eric Prystowsky, disclosed full details of his relationship with industry during his lecture.

[Editor’s note: Ellenbogen's disclosure form on the afibprofessional.org website, as of earlier this week, listed a financial relationship with Sanofi-Aventis, one of the site's sponsors. ProPublica listened to a recording of the lecture, and Prystowsky, did not mention his relationship with Sanofi. He handed in a disclosure form prior to the lecture, and it was posted later to the website.]

Q. Some members have said that they believe HRS has supported the increased use of implantable cardioverter defibrillators (ICDs) without providing sufficient information on side effects and populations excluded from clinical trials. Is that a fair criticism? Why or why not?

A. The society’s position on the use of ICDs is well-stated in the HRS-endorsed, evidence-based guidance available on our website. This guidance informs the utilization of devices.

Q. HRS officials wrote letters and testified in 2009 in support of Medicare coverage of cardiac ablation for Afib. A Medicare Evidence Development & Coverage Advisory Committee voted that more research needed to be done on senior populations. Why did HRS advocate for broader coverage if the evidence did not yet support it?

A. HRS did not advocate for broader coverage in this situation. In 2009, the Society’s expert insights emphasized that large multicenter prospective trials will be needed to better define the relative benefits and risks of catheter ablation, and until the results of such studies become available, catheter ablation of atrial fibrillation should be considered only in patients who have failed at least one antiarrhythmic medication and have symptomatic AF. There are published studies demonstrating the safety and efficacy of AF ablations in senior patients.

Q. The International Board of Heart Rhythm Examiners, which shares an office and CEO with HRS, offers training for device sales reps, among others. Does this present a conflict for the society, because a sister group receives money to train the reps that will sell devices to HRS members?

A. The International Board of Heart Rhythm Examiners does not provide training of any kind to industry representatives.

Q. Your group is offering exhibitors a novel opportunity this year with theradio frequency identification (RFID) badges. Which exhibitors have signed up for this, and what is the cost to participate? How does the use of these cards square with a study published in HeartRhythm Journal in January 2010 that RFID readers can cause complications to pacemakers and ICDs?

A. At this year’s annual scientific sessions, the Heart Rhythm Society will employ RFID badges. Exhibitors will not be offered an opportunity to purchase nor will they freely receive the information the society gathers from RFID readers. Exhibitors can purchase RFID information from a third-party source regarding the number of visitors to their booth only—contact information will be excluded. They do not obtain this information from the society or pay us any funds for this information.

Furthermore, all attendees were given the option to opt-out and receive a badge without an RFID embedded. This is an acceptable option for attendees with implantable cardioverter defibrillators or pacemakers.

Q. You indicate that RFID technology at the conference was being handled by a third-party company. Does HRS receive any funds or other in-kind contribution from that company for being able to place RFID readers/badges at the conference? You also indicated that contact information is not shared with exhibitors. Will they be told names of attendees at their booths, affiliations of those doctors, their city/states and how long they spent at the booth? This information was recently conveyed as part of the ACC’s meeting.

A. The Heart Rhythm Society does not receive royalties or any other in-kind contributions for RFID technology at our annual Scientific Sessions. The exhibitors will not receive names, contact information or affiliations of attendees, but city and state information will be captured as well as length of time spent at the booth.

Q. Your website includes patient information, including sheets on treatments. In reviewing the sheets on cardiac defibrillators and catheter ablation, they make no mention of risks, limitations or groups for whom these treatments are not recommended. Should these sheets include a more-complete discussion so patients can make informed decisions?
A. The Heart Rhythm Society believes that the most-informed discussion of the risks and limitations of treatments are best conducted between a patient and his/her physician. Please note: We include physician and patient information on our website, but also provide the following:

“Please note: As mentioned, this website is not intended to cover all aspects of any medical condition. It is generalized and is not intended as specific medical advice. Those with questions or who need more information should check with their physician or use the Society’s Find a Specialist tool, which is a publicly searchable directory of the Society’s physician members (e.g., Cardiologists, Electrophysiologists, Interventionalists, etc.) who have requested to have their contact and practice information listed for patient and physician referral purposes.”

Link: http://www.hrsonline.org/PatientInfo/

Q. Some researchers on conflicts of interest say that when a medical society receives half of its funding from industry, it is codependent on them and therefore will—consciously or not—avoid criticizing the products they make. How would you respond?

A. The Heart Rhythm Society’s first and foremost concern is to provide effective and appropriate treatment options to our patients. It is imperative that we interact with industry to develop better therapies and test them thoroughly in rigorous clinical trials. For this reason, we believe that interacting with industry is not inherently wrong with the correct measures in place to mitigate the possibility of conflicts of interest.

Moreover, the Society maintains a neutral position on all products and services offered by industry. The U.S. Food and Drug Administration is our source for information about new products, safety alerts and drug recalls. When new or updated information is disseminated by the FDA relative to electrophysiology, we first determine whether it has an impact on patient care. If so, we disseminate the FDA’s updates whether industry products are cast in a positive or negative light. Again, our priority and concern is to our patients.

A full description of the Society’s safeguards to prevent industry bias can be found in our “Guidance for the Heart Rhythm Society Pertaining to Interactions with Industry,” which will be released on Thursday, May 5, 12:15 p.m. PT at Heart Rhythm 2011, the Society’s 32nd Annual Scientific Sessions. This document is a great example of the introspection that continually occurs at the Society to review and update our safeguards, policies and procedures to appropriately monitor relationships and provide optimal oversight.

Q. You indicate that you intend to diversify your sources of funding. What does diverse mean? Are you seeking non-industry funding and, if so, from where?

A. Diverse means “from multiple sources.” HRS receives revenues from 10+ different categories ranging from industry funding to membership dues, to product sales, to investment income. All current and future sources of revenue align with our mission and strategic goals. Our Form 990 tax return (available on www.guidestar.org, or upon request) details our multiple revenue sources.

Q. You indicate that the society strives for transparency. But is transparency enough when so many board members have relationships with the companies that fund the society and have commercial interests in selling their products?

A. The Heart Rhythm Society believes that transparency, along with the policies and procedures we have in place to safeguard against conflicts of interest, misunderstandings and perceptions of bias, will help to ensure that we remain effective in board considerations and decisions. We believe that collaboration—with appropriate boundaries—is not bad, but is actually required for producing creative solutions for our patients. We know that some risk of perception of bias may be necessary in order for us to continually provide life-saving and life-enhancing solutions to our patients. However, the Society insists on transparency and adherence to multiple safeguards. This is fundamental to the medical endeavor.

Q. Several of your major funders are under investigation by federal prosecutors or have paid millions to settle allegations that they gave kickbacks to electrophysiologists for using their products. Is it appropriate for these companies to exhibit at your conference?

A. The Heart Rhythm Society is not involved in these matters and as a result, can’t really speak to them.

Follow on Twitter: @charlesornstein@tracyweber

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Kevin Pho

MD blogger faults Children’s for firing nurse linked to patient’s death

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Dr. Pho

Medical blogger Dr. Kevin Pho argues today on his weblog KevinMD.com that Seattle Children’s erred when it fired Kimberly Hiatt, the pediatric critical care nurse whose medication error has been blamed for the death of infant being cared for at the Seattle medical center.

Hiatt, 50, took her own life last month. Friends reported that she had despaired of ever finding a nursing job again.

Dr. Pho writes:

Kimberly Hiatt made a mathematical error that led to the tragic death of an infant patient. Firing her simply absolved the hospital from their share of the blame. Instead, she should have been involved with the subsequent improvement process to prevent future errors.

For more:

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Grape tomato recall includes products sold in southwest Washington

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A recall of products containing grape tomatoes has been expanded to include fresh kabobs made with grape tomatoes sold in Safeway, Vons, Pavilions and Pak N Save stores in ten states including stores in southwestern Washington, the Safeway Company announced today.

The grape tomatoes, which were supplied by Taylor Farms and the grower Six L’s are being recalled because of concerns that they may be contaminated with the bacteria Salmonella.

A list of the recalled items is below

The recalled kabobs were sold between April 26, 2011 and May 3, 2011 and have a Sell By Date up to and including May 3, 2011, the The kabobs were sold in Safeway, Vons, Pavilions and Pak N Save stores in Arizona, California, Colorado, Wyoming, Nebraska, Nevada, New Mexico, Oregon, South Dakota and Southwest Washington State.

To date, no illnesses have been reported that have been linked to the recalled products, the company said.

Customers are asked to discard these products or return them to their local store for a full refund. Customers who have questions about the recall can contact Safeway at 1-800-SAFEWAY or Taylor Farms at 209-835-6300 between the hours of 8am to 5pm PST, Monday through Friday, or visit the FDA website at www.FDA.gov.

Details about Salmonella from the Safeway press release:

Salmonella is an organism that can cause serious and sometimes fatal infections, particularly in young children, the elderly, and persons with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and/or abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis.

Salmonella can cause foodborne illness (salmonellosis) through cross- contamination. Consumers are reminded to wash their hands before and after handling eggs. For more information, please visit the Centers for Disease Control and Prevention’s Web site at www.cdc.gov

The list of the recalled items:

The recall effects the following kabobs, including any additional kabobs made with grape tomatoes.

Item Description UPC

————————————————– ———–

SALMON ATLANTIC KABOB 23037000000

————————————————– ———–

SALMON ATLANTIC KABOB MESQUITE 23037100000

————————————————– ———–

SCALLOP SEA KABOB W/VEGETABLES 23040600000

————————————————– ———–

SHRIMP KABOB WITH VEGETABLES 23040700000

————————————————– ———–

TUNA KABOBS FRESH 23040900000

————————————————– ———–

HALIBUT KABOB W/VEG 23040500000

————————————————– ———–

SALMON KABOB W/VEGETABLES FRESH 23363900000

————————————————– ———–

SALMON ATLANTIC KABOB MESQUITE 23364000000

————————————————– ———–

SALMON ATLANTIC KABOB MARINATED 23364000000

————————————————– ———–

SALMON KABOB W/VEGETABLES FRESH 23363900000

————————————————– ———–

SALMON KABOB W/VEGETABLES FRESH 23363900000

————————————————– ———–

HALIBUT KABOB FRESH WITH VEGETABLES 23180700000

————————————————– ———–

TUNA KABOBS FRESH 23513400000

————————————————– ———–

SHRIMP KABOB WITH VEGETABLES 23875100000

————————————————– ———–

SCALLOP SEA KABOB WITH VEGETABLES 23700400000

————————————————– ———–

SALMON ATLANTIC KABOB MARINATED 23364000000

————————————————– ———–

BEEF KABOBS WITH VEGETABLES 20173200000

————————————————– ———–

BEEF KABOBS WITH VEGETABLES 20725100000

————————————————– ———–

BEEF KABOBS WITH VEGETABLES 20888800000

————————————————– ———–

CHICKEN KABOBS WITH VEGETABLES 20746000000

————————————————– ———–

CHICKEN KABOB TERIYAKI WITH VEGETABLES 20746100000

————————————————– ———–

TURKEY KABOB WITH VEGETABLES 20747500000

————————————————– ———–

PORK KABOB WITH VEGETABLES 20948200000

————————————————– ———–

MILD ITALIAN SAUSAGE KABOB WITH VEGETABLES 25014400000

————————————————– ———–

BEEF KABOBS TERIYAKI WITH VEGETABLES 20944000000

————————————————– ———–

SAUSAGE SMOKED KABOB WITH VEGETABLES 20948400000

————————————————– ———–

GOURMET CHICKEN KABOB WITH ZUCCHINI & TOMATO 20974700000

————————————————– ———–

MARINATED CHICKEN KABOB WITH ZUCCHINI & TOMATO 20974800000

————————————————– ———–

GOURMET BRATWURST KABOB WITH MUSHROOMS AND TOMATO 20974900000

————————————————– ———–

SAUSAGE KABOB GOURMET 20975800000

————————————————– ———–

CHICKEN KABOB GOURMET ZUCCHINI TOMATO 20894300000

————————————————– ———–

CHICKEN KABOB MARINATED ZUCCHINI TOMATO 20894400000

————————————————– ———–

BRATWURST KABOB GOURMET MUSHROOM TOMATO 20894500000

————————————————– ———–

SAUSAGE KABOB GOURMET 20895300000

————————————————– ———–

PORK KABOB WITH VEGETABLES 20347300000

————————————————– ———–

SAUSAGE ITALIAN MILD WITH VEGETABLES 20430200000

————————————————– ———–

CHICKEN KABOB W/VEGETABLES 20923300000

————————————————– ———–

TURKEY KABOB WITH VEGETABLES 20599000000

————————————————– ———–

SAUSAGE SMOKED KABOB WITH VEGETABLES 20442700000

————————————————– ———–

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per capita

U.S. health costs, already highest, rising faster as well

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While health spending is rising faster than incomes in most developed countries, it is rising fastest in the United States, which already spends far more per person than any other country, according to a report prepared by the Kaiser Family Foundation.

 

Total Health Expenditure per Capita, U.S. and Selected Countries, 2008

Total Health Expenditure per Capita, U.S. and Selected Countries, 2008

“Since 1980, the U.S. also has had among the highest average annual growth rates in per capita spending on health care,” the report notes. “Despite this relatively high level of spending, the U.S. does not appear to provide substantially greater health resources to its citizens or achieve substantially better health benchmarks, compared to other developed countries.”

Growth in Total Health Expenditure Per Capita, U.S. and Selected Countries, 1970-2008

The report concludes:

Faced with expanding public deficits, and growing health care costs, American policy makers may elect to examine the tools employed by other countries to rein in costs. The growing difference between America’s spending and other developed countries may encourage an examination of what people in the U.S. are getting for their healthcare dollar.

To learn more:

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Photo by Brainloc

Remaking Medicare: Saving money or shifting costs?

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By Julie Rovner, NPR News
This story comes from KaiserHealthNews partner NPR

Photo by Brainloc

There’s no debating that the budget blueprint passed by the U.S. House of Representatives last month would make major changes to the Medicare program for the elderly and disabled.

What Republicans and Democrats don’t agree on, however, is whether those changes would actually save money or just shift costs now paid by the government to Medicare patients.

Rep. Paul Ryan (R-WI), who as chairman of the House Budget Committee wrote the plan that passed that chamber, says his plan would help bring down costs.

“We say, let 40 million seniors have choice, have power, and have those providers compete against each other for their business so they’re in charge of their Medicare,” he said during the House debate.

But Democrats — led by President Obama — say the GOP plan would merely let the government pay less by making Medicare patients pay more.

“I mean, it’s not hard to save the government money if you’re willing to just say, ‘Here, you pay for it,’ ” the president said at a town hall meeting in northern Virginia two weeks ago. “That’s not a solution.”

At the heart of Ryan’s plan for Medicare is a proposal to give everybody in the program a limited pot of money every year instead of the government-run health insurance they get now. But it’s not really a pot of money. Technically, it would be a subsidy they could only use to buy private health insurance.

Ryan says the plan would make Medicare work just like the health insurance he gets as a member of Congress.

“Look at all these plans we get to choose from,” he said, reading from the federal employees health plan handbook on the House floor during the debate. “Kaiser, Aetna, Blue Cross/Blue Shield, Coventry — pages and pages of choices and options. This is what we’re talking about for people [ages] 54 and below.”

Or not.

Rising Costs, Inflation

“It’s not at all what you’ll have,” says Austin Frakt, a health economist at Boston University who co-authors a health blog called The Incidental Economist.

Frakt says one key advantage of the health plans available to members of Congress is that the subsidy they get to pay their health insurance premiums keeps up with rising health care costs.

“It keeps pace, it doesn’t erode over time,” he says.

That wouldn’t be the case with Ryan’s Medicare plan. It’s designed so that the amount seniors get to buy insurance would only go up as fast as inflation in the rest of the economy. Frakt says that could be a big problem. Health costs tend to rise much faster, sometimes twice as fast, as overall inflation.

“That difference means that the subsidy is kind of riding along, going up at a slow rate, and health care costs are going way up, and premiums reflect health care costs, so the entire difference is shifted to beneficiaries,” Frakt says.

In other words, Ryan’s plan allows the government to spend less on Medicare by making patients pay more — potentially a lot more.

To see exactly how much more, we did a little math experiment.

The most popular federal worker health plan is the standard option Blue Cross/Blue Shield Plan. Its total annual premium this year is just under $7,000.

The government (the employer in this case) pays just under 70 percent of that amount, and the workers (including members of Congress) pay 30 percent.

This year, those amounts would be roughly $4,900 and $2,100.

Say next year the plan’s total premium rises to $7,500; that would be a fairly modest increase of about 7 percent. Under the federal plan, the government still pays that 70 percent. So, Frakt says, using the new total, “70 percent of that is $5,250, and the difference would be what enrollees pay … $2,250.”

That’s a total annual premium increase for federal workers of $150.

Now let’s try the same exercise under the Ryan Medicare plan.

Assume, just for comparison’s sake, the first year the government provided the same $7,000 for an individual. (The subsidy would likely be considerably higher, since seniors tend to have more health problems, and their health care costs more). And assume that the first year that subsidy would be enough to cover the full cost of a low-cost insurance plan.

What happens to the subsidy, then, when that plan’s cost rises to $7,500 the next year?

“It depends on the inflation rate,” Frakt says. “But say inflation was essentially zero, the subsidy would stay the same. So that increase in $500 in the premium would be entirely paid by the beneficiary.”

In other words, the increase for the Medicare patient would be more than three times higher than the one for the federal employee. And each year, the Medicare enrollee would be responsible for that difference between overall inflation and health inflation.

‘Cost-Conscious Consumers’

Now, Ryan and his supporters dispute that exercise. They say their plan has elements that actually would reduce health care spending.

For example, Michael Cannon of the libertarian Cato Institute says having people spend their own money, rather than the government’s, helps.

“They’ll be cost-conscious consumers, they’ll choose economical health plans, they’ll put downward pressure on prices, because they will get to see the savings,” he says.

At the same time, Cannon adds, more competition within the health care industry will also help hold down prices.

“Because in order to capture the business of those cost-conscious consumers, health plans, providers, will have to find ways to cut costs while improving quality,” he says.

So far the Ryan plan is barely more than an outline. And it’s going nowhere in the Democratic-led Senate. But it’s an important marker in the emerging Medicare debate.

And that debate comes with more than a few political perils. Medicare clearly needs some kind of fix to withstand the onslaught of 78 million baby boomers.

But so far, public opinion polls show that neither Republican nor Democratic voters favor any big changes to the program.

PHOTO by Brainloc

KHN wants to hear from you: Contact Kaiser Health News

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Spoons

Ten tips to prevent an accidental overdose — FDA

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For a medicine to work for you—and not against you—you’ve got to take the right dose.

Many over-the-counter liquid medicines—such as pain relievers, cold medicine, cough syrups, and digestion aids—come with spoons, cups, oral droppers, or syringes designed to help consumers measure the proper dose. These “dosage delivery devices” usually have measurement markings on them—such as teaspoons (tsp), tablespoons (tbsp), or milliliters (mL).

Photo by Coscurro

But the markings aren’t always clear or consistent with the directions on the medicine’s package. The Food and Drug Administration (FDA) has received numerous reports of accidental overdoses—especially in young children—that were attributed, in part, to the use of dosage delivery devices that were unclear or incompatible with the medicine’s labeled directions for use.

On May 4, 2011, FDA issued a guidance to firms that manufacture, market, or distribute over-the-counter liquid medicines. The guidance calls for them to provide dosage delivery devices with markings that are easy to use and understand.

Parents and caregivers can do their part, too, to avoid giving too much or too little of an over-the-counter medicine. Here are 10 tips:

  1. Always follow the directions on the Drug Facts label of your medicine. Read the label every time before you give the medicine.
  2. Know the “active ingredient” in the medicine. This is what makes the medicine work and it is always listed at the top of the Drug Facts label. Many medicines used to treat different symptoms have the same active ingredient. So if you’re treating a cold and a headache with two different medicines but both have the same active ingredient, you could be giving two times the normal dose. If you’re confused, check with a doctor, nurse, or pharmacist.
  3. Give the right medicine, in the right amount. Medicines with the same brand name can be sold in different strengths, such as infant, children, and adult formulas. The dose and directions also vary for children of different ages or weights. Always use the right strength and follow the directions exactly. Never use more medicine than directed unless your doctor tells you to do so.
  4. Talk to your doctor, pharmacist, or nurse to find out what mixes well and what doesn’t. Medicines, vitamins, supplements, foods, and beverages aren’t always compatible.
  5. Use the dosage delivery device that comes with the medicine, such as a dropper or a dosing cup. A different device, or a kitchen spoon, could hold the wrong amount of medicine. And never drink liquid medicine from the bottle.
  6. Know the difference between a tablespoon (tbsp) and a teaspoon (tsp). A tablespoon holds three times as much medicine as a teaspoon. On measuring tools, a teaspoon (tsp) is equal to “5 mL.”
  7. Know your child’s weight. Dosage amounts for some medicines are based on weight. Never guess how much to give your child or try to figure it out from the adult dose instructions. If a dose is not listed for your child’s weight, call your health care professional.
  8. Prevent a poison emergency by always using a child-resistant cap. Relock the cap after each use. Be especially careful with any medicines that contain iron; they are the leading cause of poisoning deaths in young children.
  9. Store all medicines in a safe place. Some are tasty, colorful, and many can be chewed. Kids may think they’re candy. Store all medicines and vitamins out of your child’s (and your pet’s) sight and reach. If your child takes too much, call the Poison Center Hotline at 800-222-1222 (open 24 hours a day, 7 days a week) or call 9-1-1.
  10. Check the medicine three times before using. For any medicine, it is always good practice to first, check the outside packaging for such things as cuts, slices, or tears. Second, once you’re at home, check the label on the inside package to be sure you have the right medicine and that the lid and seal are not broken. Third, check the color, shape, size, and smell. If you notice anything unusual, talk to a pharmacist or other health care professional before using.

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

May 4, 2011

PHOTO CREDIT: Coscurro

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MichelleAndrewsQA300

Q&A: My daughter with a pre-existing condition lost her insurance, what can we do?

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Consumer health columnist Michelle Andrews answers a question from a mother whose daughter lost her insurance and was diagnosed with bipolar disorder. What are her options to get coverage?

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Operating Room

Creating a culture of safety can improve hospital care

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Safety Culture Creates Better Care for Patients

By Carolyn M. Clancy, M.D.

May 3, 2011

The more we know about safety, the better.

That’s why a landmark report on medical errors from the Institute of Medicine remains as important today as it did when it came out 10 years ago. Called “To Err is Human,”  the report urged hospitals to develop a “culture of safety” to reduce risks and improve care for patients.

Today, safety culture plays a big role in health care. Doctors, nurses, and other health care workers are learning that a positive safety culture can improve patient care.

What does safety culture in a hospital look like?

A survey developed by the Agency for Healthcare Research and Quality (AHRQ) allows hospitals and other health care settings to measure safety by asking staff to rate things like teamwork and communication about errors. The survey launched in 2004. Since then, more than 338,000 employees from 855 hospitals have used the survey.

Employees give responses to statements such as “Staff feel like their mistakes are held against them,” and “Staff feel free to question the decisions of or actions of others with more authority.” They also give feedback on whether they report mistakes that could hurt a patient, even if no harm was done.

These responses help hospitals recognize what works well and where they need to improve. Sixty percent of hospitals that have taken the survey repeat it to see if their safety culture has changed.

When clinicians feel that they can talk openly about conditions that could harm patients, care improves.

As evidence, hospital units that have open communication have fewer medication errors, a new study from the University of North Carolina finds.

In this study, nurses at 148 hospitals were surveyed over a five-month period. They were asked questions about their willingness to report errors, whether their unit talked openly about errors, and how often they thought about whether an error might occur. Nursing units averaged 3.7 medication errors within 6 months. But nursing units with more open communication had fewer such errors.

Dr. Carolyn Clancy

How can you tell if your hospital has a good patient safety culture? Surveys and training tools that address safety culture are relatively new, so most hospitals are still learning about how they can improve.

But other tools can indicate a hospital’s overall quality.

For example, Hospital Compare, an online tool from the Federal government, lets you compare the quality of care at hospitals. Hospital Compare includes results from a survey that asks patients about their recent hospital stay. Patients tell about communication with doctors and nurses, how they rate the hospital, and whether they would recommend the hospital.

Many hospitals are learning how to create a culture of patient safety. Their patients will benefit from this effort.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Surveys on Patient Safety Culture: Hospital Survey on Patient Safety Culture
Available at: http://www.ahrq.gov/qual/patientsafetyculture/hospsurvindex.htm#Toolkit

Effects of learning climate and registered nurse staffing on medication errors. [Nurs Res 2011 Jan-Feb].
Available at: http://www.ncbi.nlm.nih.gov/pubmed/21127452

Department of Health and Human Services
Medicare Hospital Compare Information for Consumers—Overview
Available at: http://hospitalcompare.hhs.gov/staticpages/for-consumers/for-consumers.aspx

Medicare Hospital Compare Information for Consumers—Patients’ Survey
Available at: http://hospitalcompare.hhs.gov/staticpages/for-consumers/hcahps/patients-hospital-experiences.aspx

Institute of Medicine
To Err is Human: Building a Safer Health System. November 1999.
Available at: http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx

Current as of May 2011


Internet Citation:

Safety Culture Creates Better Care for Patients. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, May 3, 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc050311.htm

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Acetaminophen overdoses send tens of thousands to ER each year

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By Lisa Esposito, Editor
Health Behavior News Service

Overdose of the common household drug acetaminophen leads to more than 78,000 emergency department (ED) visits a year, and the majority of the overdoses are intentional, according to a new study from the Centers for Disease Control and Prevention.

It’s a big problem, and the study found three main causes among ED patients.

“About 70 percent are for self-harm attempts, and 13 percent to 14 percent are kids getting into products,” said lead study author Daniel Budnitz, M.D. “The other 16 percent are the adolescents and adults that generally fall into two groups: the younger adults that are misusing over-the-counter products because they are trying to get better pain control and don’t understand the risks, and the older adults that are making some errors using the opioid combination products.”

Consumers take acetaminophen — the active ingredient in Tylenol — to reduce pain or fever, as a single drug in tablets, capsules or liquid. Acetaminophen combines with other drugs in a variety of over-the-counter cold, flu and sinus medicines including Theraflu, Triaminic and Sudafed. Acetaminophen also appears in combination with an opioid — a narcotic— in prescription medicines like Vicodin (with hydrocodone) or in Percocet (with oxycodone).

Taken correctly, acetaminophen is safe and effective, but the margin between a therapeutic and a dangerous dose is smaller than many people might realize.

ED visits related to abuse of acetaminophen products were not included in the study, which appears online and in the June issue of the American Journal of Preventive Medicine.

Young people ages 15 to 24 are at highest risk for suicide attempts or acts of self-harm involving acetaminophen, the researchers found. “Because these data are based on ED records, it is often difficult to determine exactly what motivated the patient — if they had a premeditated plan to end their life with an overdose or if the overdose was an impulsive act,” said Budnitz, medical officer at the Division of Healthcare Quality Promotion.

Among the others in this age group, 75 percent of ED visits occurred because they went above the recommended acetaminophen dosage in search of quicker or stronger relief.

Overdoses by people who think more medicine is better points to a deep knowledge gap and need for better consumer education about a familiar drug, said Henry Spiller, director of the Kentucky Regional Poison Center. He has no affiliation with the study.

“We frequently see that with abdominal pain or tooth pain. They can’t get to the dentist for a day or two so just try to manage the pain themselves. Some actually come in with frank liver failure,” Spiller said. “I think they’re unaware that they’re risking something as bad as liver failure—especially with tooth pain.”

Taken correctly, acetaminophen is safe and effective, but the margin between a therapeutic and a dangerous dose is smaller than many people might realize.

“The toxic dose depends on the age of the person, how much they weigh and their liver function, but in general, 10 to 15 grams can cause what’s called hepatic necrosis, which is basically the liver cells dying,” Budnitz said. “So 10 grams — an extra-strength tablet is 500 milligrams of acetaminophen — that’s about 20 tablets.”

The poison center might recommend to people who take acetaminophen continually that they should instead alternate with another pain medicine, like ibuprofen, Spiller said.

“If you double or triple the dose of acetaminophen, and you take it for several days, you will cause significant liver problems,” Budnitz said. Rather than a sudden, dramatic reaction, overdose symptoms often occur later, he said. “If untreated, the acetaminophen toxicity can take days, maybe weeks, to manifest itself.

“Depending on the person, and how much they took and what treatments they get, the outcomes range from full recovery to possible death without a liver transplant,” Budnitz said. “If you or someone you know did take an overdose of acetaminophen, the first thing to do is to call the poison center (1-800-222-1222), follow their advice, and, if directed, go immediately to the emergency department for an evaluation.”

The good news: “With prompt treatment most patients fully recover, especially children, because acetaminophen does have an antidote. If given promptly, that can protect the liver, ” Budnitz said.

Overdoses caused by extra doses for symptom relief or other mistakes were more likely to involve over-the-counter products in people ages 15 to 24, and opioid-containing acetaminophen products in people older than 39.

For those who require the antidote, it is not as simple as taking a pill. “NAC comes in oral and intravenous form,” Spiller said. “NAC is sulfur-based and it smells like rotten eggs. It’s tough to get kids to drink it.” Others who overdose might undergo “gastric decontamination” with an unpleasant charcoal mixture or by having their stomach pumped.

The study analyzed two years of data from the National Electronic Injury Surveillance System to estimate the number of annual ED visits nationwide. The actual sample included 63 U.S. hospitals and findings relied on 2,717 cases.

Local Resources:

  • Washington Poison Center Hotline: 1-800-222-1222 (Website: www.wapc.org)

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

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For young adults, best option is likely their parents’ plans

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Image by Michal Zacharzewski

By Michelle Andrews

In past years, a student’s graduation could mean leaving behind not only the classroom but also health insurance coverage, since family plans often stopped covering dependent children once they left school.

The health-care overhaul has changed that: Adult children can now remain on their parents’ plan until age 26, with few exceptions. (More on that later.) But even if coverage under a family plan isn’t an option, the new law has helped ensure that some of the other choices available to young adults offer better protection than they have in the past.

For many graduates, staying on their parents’ plan is likely to be the best option. “Most employer plans have good benefit packages,” says Sara Collins, a vice president at the Commonwealth Fund, a private organization that studies health-care issues. Keeping an adult child on the family policy probably won’t significantly affect the premium, his or her existing conditions continue to be covered and the new graduate can keep using the same doctors.

Rochelle O’Sullivan is relieved that she can stay on her mother’s plan after she graduates from Boston University this spring. The 22-year-old is on crutches after breaking her hip when she slipped at the airport on her way home to San Francisco for spring break in March. Having health insurance while she mends is critical. But once she kicks her job search into high gear, O’Sullivan doesn’t want health insurance concerns to get in the way.

“I’m worried about getting a job, getting experience,” says the mass communications major. “And if that means taking a job without insurance, I’d do that.”

The law applies to adult children whether or not they live at home or are financially independent. Even married children can stay on their parents’ health policy until age 26.

More From This Series: Insuring Your Health

The biggest wrinkle for young adults: If they take a job whose benefits include health insurance, they can’t choose to stay on their parents’ plan.

If that job offers good coverage, that’s not a problem. But new grads often take entry-level or part-time jobs, which can come with limited-benefit plans that offer low coverage limits providing little protection if they actually get sick.

According to the Department of Health and Human Services, however, even inadequate, so-called “mini-med” policies count as insurance, and if young adults are offered such coverage, they can’t be covered under their parents’ plans. Once the health-care law is fully implemented in 2014, mini-med plans will be phased out.

The Bryant family has been negotiating this tricky period. Kelli and Kirk Bryant’s oldest son, Dylan, 21, graduated last September and was working part time at a retailer while looking for a full-time job. The retailer offers a limited-benefit policy with $50,000 in coverage annually, not nearly as good as the comprehensive plan the family has through Kirk’s job at a hospital in Lincoln, Neb.

Ironically, being offered a job without health insurance is, in this instance, a good thing.

The retailer said Dylan wasn’t eligible for its insurance, but Kelli was worried that that was a mistake and that he might be on thin ice if questions arose.

That’s no longer a concern. Recently Dylan took a new part-time job as a security specialist at a mental health facility. The new job doesn’t offer health insurance, leaving no doubt that Dylan is free to be covered under the family plan.

Ironically, being offered a job without health insurance is, in this instance, a good thing, says Kelli, who says she has contacted one of her U.S. senators about tightening up the definition of on-the-job insurance for young adults.

Of course, many adult children don’t have access to a family health plan. Their parents may not have coverage on the job. Or if the parents are on Medicare or are part of a retiree-only health plan through a previous employer, the new provisions extending coverage up to age 26 don’t apply. But there are other options for young adults.

If they’re healthy, an individual insurance policy may be a reasonable choice. Although coverage is often not as comprehensive as it is with a group plan, individual policies can no longer impose lifetime coverage limits or, in most cases, annual limits, and they must provide a range of preventive services for free. Premiums for young, healthy people may be very affordable,
say experts.

Uninsured young people with preexisting medical conditions can consider special state-based insurance plans created under the health-care law. But they can be pricey, and you have to have been uninsured for six months to qualify.

Although the family policy is likely to be the best option, high school graduates going on to college should consider their college’s health plans, say experts. Some are good plans, and recent proposed regulations would require many of them to be classified as individual health insurance plans, with similar protections and standards.

That should result in many of the worst student plans shutting down, says Stephen Beckley, a health-care management consultant for colleges and universities in Fort Collins, Colo. “We expect many plans to drop off between 2012 and 2014,” he says.

Still wondering what to do? Young Invincibles, a health-care advocacy group for young adults, has developed a toolkit to help grads assess the options.

“When you graduate, you get an exit interview to discuss your student loans,” says Aaron Smith, the organization’s co-founder and executive director. “There’s nothing like that for health insurance.”

IMAGE by Michal Zacharzewski

KHN wants to hear from you: Contact Kaiser Health News

LocalHealthGuide Resources:

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Quinault Tribal Enterprise recalls all canned seafood products because of possible health risk

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Quinault Tribal Enterprise of Taholah, WA is recalling all canned seafood products including:

  • all Salmons, smoked and non-smoked;
  • Tuna, smoked and non-smoked;
  • Smoked Sturgeon;
  • Minced Razor Clams;
  • smoked Razor Clams;
  • and smoked Steelhead.

The products are packaged in metal cans in various sizes (5oz, 6oz, 6.5oz, and 7oz) and labeled under the Quinault Pride or Quinault Tribal Enterprises brand. All manufacturing codes are subject to this recall.

The canned seafood products are being recalled because they were not adequately processed according to the U.S. Food and Drug Administration’s low-acid canned food regulations, the company said in a press release announcing the recall.

“Canned seafood that is not processed following those food safety requirements may be contaminated with harmful microorganisms that can cause serious and possibly life-threatening illness,” the company said — and warned consumers not to use the products even if they do not look or smell spoiled.

No illnesses or injuries have been reported to date, the company said.

The recalled products were distributed nationwide through distributors and retail stores.

Consumers who have purchased Quinault Pride Brand are urged to return it to the place of purchase for a full refund. Consumers with questions may contact the company at 1-800-982-8650 Monday through Friday between 8:00am and 3:00pm Pacific Time.

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