The Settlement and Conviction Round-Up: Friday Frequent Flier Edition

It’s time for one of our periodic round-ups of legal settlements and convictions of health care organizations.  This time, we report on three frequent fliers, in chronologic order of the appearance of the relevant news stories.

Robert Wood Johnson University Hospital Hamilton (UMDNJ)

We have written multiple times about the woes of the University of Medicine and Dentistry of New Jersey, which lead to a deferred prosecution agreement and operation under the watchful eye of a federal monitor for several years, and resulted in criminal convictions of a former Dean and the state legislative leader he hired.  Scroll through this for far too many details. 

Now, the redoubtable Newark Star-Ledger reports:

Robert Wood Johnson University Hospital in Hamilton has agreed to pay $6.35 million to settle allegations that the facility defrauded Medicare, Justice Department officials said today.

The Mercer County hospital was accused of inflating charges to Medicare patients to obtain bigger reimbursements from the federal government.

‘Taxpayer dollars should go towards quality health care, not wasted on fraud and abuse,’ said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice.

The hospital denied wrongdoing in the settlement, said Skip Cimino, the facility’s president and CEO. ‘Robert Wood Johnson University Hospital Hamilton has resolved the outstanding Medicare Reimbursement issue with the government and looks forward to continuing its service to the community,’ he said.

Note that Robert Wood Johnson Medical School is one of the two medical schools contained within UMDNJ.

Fresenius

I admit that we last discussed Fresenius Medical Care Holdings Inc, a for-profit provider of kidney dialysis services, a while ago, back in 2007. At that time, the company settled charges made by the US Federal Trade Commission that it had tried to restrain competition. Last week, the Tennessean reported:

A long-running whistleblower complaint against the once-Nashville based Renal Care Group has led to a $19.3 million federal court judgment against the acquired dialysis supplier and the German company that bought it four years ago.

The lawsuit, which focused on improper claims submitted to Medicare for home dialysis supplies, named Renal Care Group Supply Co. and Fresenius Medical Care Holdings Inc., as co-defendants. The federal government joined the whistleblower complaint more than two years ago.

Renal Care operated a shell billing company solely to submit claims on behalf of itself in violation of federal law that requires suppliers to be independent of the dialysis facilities where patients are treated, the government said. Even after employees raised concerns, Renal Care continued to operate the billing company because of the ‘illicit revenues it created,’ the suit said.

One employee wrote: ‘I do not wish to go to jail’ and felt the company’s plan ‘was not in the best interests of patients,’ said federal Judge William J. Haynes Jr. of Nashville in his ruling.

The billings reportedly occurred over a six-year period beginning in 1999. The Fresenius-Renal Care acquisition closed in 2006 at a sales price of $3.5 billion.

Pfizer

Pfizer Inc, which proclaims itself to be the world’s largest pharmaceutical company, has provided an amazing amount of material for Health Care Renewal. In September, 2009, we discussed the huge, that is, $2.3 billion dollar settlement Pfizer made of criminal and civil fraud charges. At that time, this was the fourth settlement of charges of unethical marketing made by Pfizer since 2002.

Since then, we have discussed another fraud settlement in October, 2009, and yet another in January, 2010.

Today, Bloomberg reported:

Pfizer Inc. violated U.S. racketeering law in the marketing of its epilepsy drug Neurontin and should pay $142.1 million in damages, a jury decided.

Kaiser Foundation Health Plan Inc. and Kaiser Foundation Hospitals claimed in a monthlong trial in federal court in Boston that Pfizer illegally promoted Neurontin for unapproved uses. The insurer said it was misled into believing migraines and bipolar disorder were among the conditions that could be treated effectively with Neurontin, approved in 1993 by the U.S. Food and Drug Administration for epilepsy.

‘The jury found Pfizer engaged in a racketeering conspiracy over a 10-year period,’ Tom Sobol, a lawyer for Kaiser, said after yesterday’s verdict. ‘That bodes well for future cases.’

Furthermore, this was a very special kind of verdict:

The jury, which deliberated for two days, found that New York-based Pfizer violated the federal Racketeer Influenced and Corrupt Organizations Act, or RICO, and California’s Unfair Competition Law. Under RICO, the amount of actual damages found by the jury, $47.36 million, will be tripled.

The RICO statute was meant to be used against organized crime.  A jury seems to have found that Pfizer is a “Racketeer Influenced and Corrupt Organization,” that is, the moral equivalent of a crime syndicate.

Summary

So this week’s settlement and conviction round-up shows the impunity that many health care organizations have exhibited thus far.  Some organizations have been charged again and again with unethical behavior.  Now one of the most frequent of the fliers has been convicted under the RICO law, certainly a new low.

Yet none of the affected organizations in this post, and precious few we have discussed at other times, seem to have suffered any major consequences.  All have paid fines, some which seemed large at the time, but which have never been large enough to seriously threaten the organizations’ financial well being.  None of the organizations seems to have lost business, or even much reputation.  Very few of the people within the organizations who approved, lead or implemented unethical behaviors have suffered any sort of negative consequences.

There seems to be something very wrong here.  In the US, we have put much of our health care system in the hands of very large organizations, for-profit and not-for-profit, without holding these organizations and their leaders accountable for their actions.  The results have been increasingly rich leaders who often behave like a new aristocracy, and repeated bad behavior by the organizations they lead. 

Our latest effort at health care “reform” has continued to rely on large private organizations, while so far not adding to their or their leaders’ accountability.  In my humble opinion, if we really want to reform health care so as to improve quality, increase access, control costs, and support professionalism, we will have to make our new health care oligarchs accountable.

"Misuses of EBM"

In an excellent article(1) just published in JAMA on progress in evidence-based medicine, Montori and Guyatt devote a section to the misuses of EBM, worth quoting in its entirety herewith emphasis added.

An analogy can be made between EBM and nuclear fission: it can be very powerful when used appropriately and dangerous when used inappropriately. The term evidence-based precedes many recommendations, guidelines, and algorithms that are not transparently linked to the underlying evidence base and do not represent the results of a systematic and critical appraisal of that evidence. It sometimes appears as if using the term obviates the need to describe the quality of underlying evidence, the magnitude of effects, or the applicability of any of the results in the context, values, and preferences of the patients.

This is particularly problematic because the EBM era has coincided with a dramatic increase in the for-profit funding of research. Researchers funded by industry interpret their results differently and in favor of the industry product relative to not-for-profit funding. Problems associated with industry funding include use of inappropriate control interventions, surrogate outcomes, publication and reporting bias, and misleading descriptions and presentations of research findings—all forms of corrupting the evidence base. Unsophisticated users of the medical literature, assuming that medical editors, peer reviewers, and topic experts have now become familiar with the tenets of EBM, may trust these corrupted research reports and advocate for their application in practice.

Many medical schools and training programs, in a form of premature closure, are moving away from teaching the fundamentals of careful evidence appraisal to emphasize the implementation of evidence. The intent of this new focus is to produce high-quality, safe, and low-cost care (ie, Accreditation Council for Graduate Medical Education competencies of systems-based practice and improvement and practice-based learning14). However, abandoning appropriate skepticism regarding the effectiveness of these interventions may lead to large investments in quality-improvement, safety, and efficiency activities that fail to yield the expected benefits.

We are truly making progress when there is now such public recognition of threats to evidence-based medicine, and thus to the rational and compassionate practice of medicine based clinical knowledge, and on both critical review of the best available clinical evidence, and sensitivity to patients’ values.

I should underline the points made in the last paragraph quoted. It is distressing that what little progress in making evidence-based medicine part of medical education we made in the 1980s and 1990s is being wiped out. But what should we expect of medical schools staffed by faculty and faculty leaders who mostly are paid by the companies that make the drugs and devices that are the subject of their teaching and research?(2-3) And what should we expect of medical schools that now depend on large infusions of money from these same companies? Truly rigorous EBM might actually show that some of these “innovative” drugs and devices are not quite as good as the marketing says. So teaching same may distress the faculty’s employers and the university’s benefactors.

If we expect the teaching of rational and compassionate medicine that puts the benefit of patients first, we need medical schools and medical faculty who are not paid by companies whose first priority is increasing profits by selling as many drug doses and devices they can.

References

1. Montori VM, Guyatt GH. Progress in evidence-based medicine. JAMA 2008; 300: 1814-1816. Link here.

2. Campbell EG, Gruen RL, Mountford J et al. A national survey of physician–industry relationships. N Engl J Med 2007; 356:1742-1750. Link here.

3. Campbell EG, Weissman JS, Ehringhaus S et al. Institutional academic-industry relationships. JAMA 2007; 298: 1779-1786. Link here.

The Avandia Spin Cycle Continues

The Avandia spin cycle continues to whirl. First, let me back-track a bit. In my humble opinion, the questions raised by the Avandia case, which started recently with the publication in the New England Journal of Medicineby Nissen and Wolski of a meta-analysis focused on cardiac adverse effects of rosiglitazone (Avandia, by GlaxoSmithKline) (see post here) are twofold.

The first question is clinical: what are the benefits and harms of rosiglitazone as a treatment of Type 2 diabetes, and therefore for which patients under what circumstances should this drug be used?

The second question is about policy: what barriers, if any, have prevented physicians and patients from getting the best possible answer to the first question, and what can be done about them?

Regarding the second question, keep in mind that the main achievement of the Nissen and Wolski meta-analysis [Nissen SE, Wolski K. Effects of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med 2007; 356, online here] was to be the first published article to combine data from all relevant clinical trials of rosiglitazone completed to date. Although two major trials of Avandia had been published, its manufacturer, GlaxoSmithKline, had performed many other smaller trials of the drug, most of which have not been published to date. They did eventually appear on a web-site run by GSK. However, this web-site was relatively obscure, and it was not created voluntarily, but in response to a settlement of legal action that alleged GSK had suppressed clinical research about its antidepresant paroxetine (Paxil). (See Steinbrook R. Registration of clinical trials – voluntary of mandatory. N Engl J Med 2004; 351: 1820-1822, link here and our post here). Nissen and Wolski found it, compiled the results of trials on Avandia, and combined their results with those of the few published trials in their meta-analysis.

It is to the credit of Nissen and Wolski to figure out how to do this. It is not to the credit of GSK that they sat on the data from these trials, only put it on this web-site when compelled to do so, did not make any effort to publicize the web-site, and did not publish a meta-analysis done by company scientists that showed qualitatively similar results to that done by Nissen and Wolski (see post here).

However, the spin cycle now in progress does little to answer these questions. Instead, it seems to obfuscate them. The latest revolutions in the cycle are…

GSK published a full-page advertisement in major newspapers including a letter to Avandia patients. The relevant parts of the letter are:

We at GlaxoSmithKline are proud to be the makers of Avandia. As leaders in diabetes, we understand that managing your type 2 diabetes is not easy. We also understand the confusion and concern you may have experienced following recent press coverage about the safety of Avandia. GlaxoSmithKline stands firmly behind Avandia.

Avandia is the most widely studied medicine for type 2 diabetes. GlaxoSmithKline has conducted an unprecendented number of clinical trials in order to continuously monitor the safety of Avandia, including its impact on the cardiovascular system. The response to this commitment from well-informed experts and researchers has been encouraging.

Like any medication, Avandia is not appropriate for all patients. Your doctor is the best resource for information about your health and is in the best position to determine if Avandia is right for you.

Be asssured, GSK gives you all our full commitment to providing you and your doctor with the facts about the safety of Avandia.

The letter obviously contains no specifics. It provides no new information about the benefits and harms of Avandia. It appears that the last sentence in the second paragraph was meant to be key, “the response to this commitment from well-informed experts and researchers has been encouraging.” What it means, however, is completely obscure.

So all GSK seems to have done with the letter is provide vaguely soothing words without meaningful specifics.

Meanwhile, the Financial Times reported on the words of the GSK CEO, Jean-Pierre Garnier (via MSN Money here).

Jean-Pierre Garnier, chief executive of GlaxoSmith­Kline, the UK-based pharmaceutical group, on Wednesday lashed out at a leading medical journal for ‘mixing science with politics’ in publishing articles attacking its diabetes drug Avandia.

As his company’s share price continued to fall, Mr Garnier told the Financial Times in an interview that New England Journal of Medicine papers raising safety concerns with Avandia were ‘smearing the drug’ as they ‘pick and choose their numbers as they are trying to make a case the FDA [the drugs regulator] is not doing its job’.

Similarly, during the Congressional hearings last week, the New York Times reported that

Representative Darrell Issa, Republican of California, said the committee was coming dangerously close to ‘politicizing science.’ And he closely questioned Dr. Steven E. Nissen, a cardiologist at the Cleveland Clinic whose May 21 article in The New England Journal of Medicine questioned the safety of Avandia.

‘This does look like in fact that this was a political concoction to anecdotally go after a company, and I object to it,’ Mr. Issa said.

I suppose Rep Issa could have objected that the Congressional hearings in which he was participating were “politicizing science,” but how a meta-analysis focused on particular adverse effects of a popular drug might be political is beyond me.

But it is one way to distract from the content of the article and the substantive clinical and policy issues it raises.

Note the similarity between the opinions of Rep. Issa and GSK CEO Garnier.

Furthermore, a commentary in the Washington Times by Peter J Pitts and Robert Goldberg took another swipe at Dr Steve Nissen. After starting out by charging that Nissen “positioned himself as the nation’s de facto drug regulatory czar.” The writers sarcastically labelled him as the “Patron Saint of Drug Safety,” and “Saint Steven the Pure.” They then went on to chastise Nissen for his involvement in two commercially sponsored studies, one on a drug “designed to reduce the level of fatty plaque deposits (atherosclerosis) in a person’s arteries, sponsored by Atherogenics, the other on “a synethetic version of good cholesterol,” sponsored by Esperion. Neither trial was apparently sucessful.

Nissen had not hidden the fact that he did commercially sponsored research. The relevance of his role in research on cholesterol lowering drugs to his meta-analysis of Avandia is unclear.

Pitts and Goldberg listed their primary affiliation as the Center for Medicine in the Public Interest. Pitts is its President, and chief blogger on the CMPI site DrugWonks. However, Pitts’ day job is to be Senior Vice President for Global Health Affairs at the big public relations firm Manning, Selvage and Lee. Manning, Selvege and Lee has many big pharmaceutical accounts, as listed on the CommuniqueLive.com site. As Senior Vice President for Global Health Affairs, Pitts is presumably responsible for all these accounts. Thus, his livelihood seems to depend largely on his ability to convey the pharmaceutical industry’s point of view. Pitts seems to be continuing in his role as a stealth health policy advocate which we first discussed in this post here.

And where else have we heard Nissen sarcastically derided as a would be saint? The Cleveland Plain Dealer reminded us,

Sen. Sherrod Brown and other lawmakers are questioning conflict-of-interest policies at the Food and Drug Administration, where an agency official with ties to the drug industry attacked industry watchdog Dr. Steven Nissen of the Cleveland Clinic.

FDA communications consultant Douglas Arbesfeld recently sent journalists a flaming e-mail about Nissen, who was the co-author of a study in the New England Journal of Medicine that raises safety questions about the diabetes drug Avandia.

The e-mail referred to Nissen as ‘St. Steven’ and included an anonymous blog item that accused the doctor of criticizing manufacturers that don’t support drug trials at the Clinic, according to ABC News online.

Brown and four other lawmakers said in a letter Thursday to FDA Commissioner Andrew von Eschenbach that Arbesfeld ‘may be using his position with the FDA to settle old scores with Dr. Nissen.’

It noted that Nissen and Arbesfeld had been adversaries in an earlier controversy over the safety of a Johnson & Johnson heart drug. Arbesfeld was a spokesman for Johnson & Johnson at the time.
The lawmakers said Arbesfeld’s e-mail may give the impression the government encourages smear campaigns against independent scientists. Their letter asks the commissioner to explain policies on hiring from drug companies and potential conflicts of interest.

An FDA spokeswoman did not respond to requests for comment Friday.

Disputing whether Dr Steven Nissen is a saint, sinner, or something else only seems to distract from the substantive questions I raised above. It is interesting that the “Saint Steven” references were made nearly simultaneously by the Vice President in charge of health care (mainly pharmaceutical) accounts of a large public relations firm and a FDA spokesperson with many previous ties to the pharmaceutical industry.

So the spin cycle revolves merrily on about the Avandia case, throwing off obfuscation after obfuscation that distract from the central issues of the case. But maybe if the pharmaceutical industry really wants to avoid being labelled “shifty,” (see post here) it could damp down the enthusiasm of its advocates for endlessly spinning this case, and address the real substantive issues: what are the harms and benefits of Avandia? were data about the drug suppressed, and if so, how can we prevent this from happening in the future.

ADDENDUM (14 June, 2007) – To those visiting via links from Clinical Psychology and Psychiatry, KevinMD, Notes from Dr RW, PharmaGossip, Retired Doc’s Thoughts, and Question Authority with Dr Peter Rost: We thank those bloggers for their kind words. Welcome to Health Care Renewal. Our goal is to discuss threats to physicians’ and other health care professionals’ core values, especially those due to concentration and abuse of power. We do end up talking a lot about questionable practices by the pharmaceutical industry and its leaders, but there are many things to question about the management and operations of other health care organizations. Please have a look, and feel free to comment.

How the legal profession disciplines it members, and other screwups related to medical malpractice

A sad personal tale of medical malpractice that ironically might have been prevented with an EMR, the legal malpractice that followed, as well as a comment on how the legal profession disciplines it members:

In this document from the National Association of Personal Injury Lawyers are the specifics of the events that led my father to miss being at the 2000 malpractice suit he initiated in 1995 for a two-year failure to diagnose bilateral renal cell adenocarcinoma and medical abandonment.

A dozen retrograde pyelograms in the O.R., performed from 1992-1994 didn’t show his problem, as they wouldn’t. They did not visualize the renal parenchyma, and despite repeated bouts of severe renal colic and GU bleeding with suspicious CT/MRI’s, nothing else was done besides prescribing percocet.

This was despite a history of prior successful treatement with nitrogen mustard and other carcinogens two decades prior for mycosis fungoides, a lymphoma. The diagnosis was always “a kinked ureter” and a stent was placed, which the doctor accused my father of “knocking loose” by picking up heavy packages, etc.

In late 1994 when I became aware of a GU bleed so severe that it dropped my father’s hematocrit several points, I demanded a renal arteriogram. At first the medical team refused, but then gave in when I basically threatened legal action (I was faculty at Yale School of Medicine at the time). According to my father, the radiologists said during the arteriogram: “ooops.” The result: bilateral golfball-sized renal carcinomas. A “special file” was opened by the hospital.

We were then told the problem was inoperable; but the doctor did not order medical or oncology consults despite my asking him to do so directly. My direct requests to the Department of Medicine to intervene were refused on the basis of “can’t get involved in this mess.” I then transferred my father to the hospital where I did my residency just as he became septic from obstruction, and after some time in the ICU to clear up his septic shock his cancers, perfectly operable via partial nephrectomies, were removed. There were fortunately no metastases.

The urologic surgeon who did the surgery informed us there were no ureteral “kinks.”

He lived without pain, and without bleeding, and without dialysis until 2000. In July 2000, he died of septic shock as a complication of dialysis for the renal failure that set in earlier that year. His battered kidneys, that had been subjected to repeated obstructions and hydronephrosis while the tumors were growing over a several-year period, finally gave out. My intervention in his case had given him six extra good years.

He filed suit for medical malpractice and abandonment in early 1995.

My father was not at the trial that did not take place until late 2000 (CHARGE VIII, Item 131: The Silverstein Matter) because the trial had been cancelled, and he died before the trial could be reinstated (itself a near precedent in Pennsylvania law). My father’s case along with multiple other major injury/malpractice cases had been dropped by the court due to malpractice attorney Thomas W. Smith’s secret problems.

My father did, however, attend the trial posthumously in the form of a videotape made under court-acceptable conditions, at my demand, since I felt my father might die before the case reinstatement matter was resolved.

My father won the case, posthumously.

At the trial, the defense had an “expert witness” (a urologic surgeon from another hospital) try to make the case that in elderly people (my father was 68 at the time the problems began) , renal cancers should be “left alone.” Of course, this did not take into account the repeated bouts of renal colic, obstruction, bleeding and pain and was, I thought, an odd defense.

Presented as evidence in this regard was an article from the American Journal of Urology that had non-operation of renal cancers in the ‘elderly’ as its thesis.

Unfortunately for the defendants, the article’s conclusion stated that such a course was experimental and that the standard of care was indeed surgery. When this ‘expert witness’ was asked by my parents’ attorney to read the article’s conclusion to the jury, he realized his error, and stammered and came out with such literal nonsense and ‘spin’ to try to explain away this little discrepancy, that I thought I was in an alternate universe. Everything I’d learned about medicine – the need to be cautious and honorable, the value of expertise, the respect for the patient – seemed to be just meaningless window dressing. (I paid for a transcript of that testimony just because I wanted to make sure I was not hallucinating at the time.)

Rubbing salt into the wounds, Medicare then put a lien on a portion of the winnings, to recover for the expense of “unnecessary procedures”, including the dozen retrograde renal studies. An amount of money was put in an escrow account. It did not matter that the patient is not the person responsible for the tests being ordered, and in Pennsylvania the jury was not permitted to be informed that Medicare could recoup some of the expense of unnecessary medical procedures. Talk about screwed up. I fought this on the basis of it being unfair, based on a technicality in the language of the act that allows such recovery, and just a few weeks ago, in 2005, Medicare released the escrow and the amounts were given to my mother. I think this was done more due to the voluminous length of my father’s records and the shortage of Medicare resources and personnel time to adjudicate my complaint, more than anything else.

My father and mother, as well as nearly a dozen other plaintiffs in numerous severe malpractice cases, suffered twice. Once, as a result of medical malpractice and then again, as a result of the legal malpractice that the National Association of Personal Injury Lawyers report linked above described as “both serious and grave in nature,” with “eleven separate instances of major case neglect and multiple instances of misrepresentations [i.e., lies] about the status of the cases on seven separate dates.”

The penalty, imposed in 2003?

Suspension from the practice of law for a period of four years, retroactive to December 13, 1998.

As to the physician involved, that’s another matter. He received a promotion to Chief of Staff. I don’t think he’s practicing law.

Did I mention the physician was attending law school at the same time he was treating my father, while also running several urologic surgery practices? We found this out only several years ago.

Dad, it’s a screwed-up world. Rest in peace.

— SS

Health Care and Coffee Drinking

How is your
Java consumption? Are you a one, two, or three cup a day drinker? Or do you
just keep a pot going with an IV attached all day? There are studies that can
prove drinking coffee is good for you and some that say it’s not that healthy.
What do YOU think?

According
to HellaWella, coffee is one of the most popular beverages in the world, but is
seemingly also one of the most maligned. However, after hundreds of years of
consumption and decades of research, it seems the benefits of drinking coffee
far outweigh the risks. However, unfiltered coffee — such as that prepared in a
French press — proves an exception, as it can elevate
cholesterol levels.

In multiple studies comparing people who drink three to five
cups of coffee per day with those who drink zero to two cups per day, it has
been found that those who drink more coffee are significantly less likely to
develop Alzheimer’s disease and have a reduced risk of developing dementia.

Moreover,
drinking caffeinated coffee has been associated with a lower incidence of gallstones and gallbladder disease in
both men and women. Similar to the results of the aforementioned Alzheimer’s
studies, it has been found that heavy coffee drinkers — those consuming
approximately 3.5 cups a day — are significantly less likely to develop Parkinson’s disease later in life, compared with
nondrinkers.

Other
health benefits of coffee include reducing one’s risk of
Type 2 diabetes by up to half, reducing the incidence
of cirrhosis of the liver, and reducing the risk of certain types of cancer.
Generally, coffee contains a substantial amount of antioxidants.

As with
any significant change in diet, you should talk to your doctor before
increasing your coffee intake. And also be mindful of what time you are
drinking your coffee, as the caffeine can have a negative impact on your sleep
patterns, which will in turn have an effect on your overall health.

According
to the Harvard School of Public Health (HSPH), often people think of coffee just as a
vehicle for caffeine. But it’s actually a very complex beverage with hundreds
and hundreds of different compounds in it. Since coffee contains so many
different compounds, drinking coffee can lead to very diverse health outcomes.
It can be good for some things and bad for some things, and that’s not
necessarily flip-flopping or inconsistent.

 

Few foods are good for everything.
That’s why studies are done on very specific health effects—for example,
studies of how coffee affects the risk of diabetes—but studies are also
conducted such as a recent one looking at coffee consumption and mortality over
a long period of time, which better reflects the overall health effect.

Coffee is
also a bit more complex to study than some other food items. Drinking coffee
often goes along together with cigarette smoking, and with a lifestyle that’s
not very health conscious. For example, people who drink lots of coffee tend to
exercise less. They are less likely to use dietary supplements, and they tend
to have a less healthful diet. So in the early studies on coffee and health, it
was hard to separate the effects of coffee from the effects of smoking or other
lifestyle choices.

Over the several
decades that coffee has been studied, there have been some reports that coffee
may increase the risk of certain cancers or the risk of heart disease. But in
better conducted studies, such as the one we just published—larger studies that
have a lot of information about all other lifestyle factors and make a real
effort to control for these lifestyle factors—we do not find many of these
health effects that people were afraid of.

HSPH also
reports that if people are not used to using any caffeine, and they start to
use caffeine, their blood pressure goes up substantially. Within a week of
caffeine consumption, however, we see that the effect is less pronounced—there
is less of an increase in blood pressure. After several weeks of continued
caffeine consumption, however, a little bit of increase in blood pressure
remains.

In studies
that look at the incidence of hypertension in the general population, drinking
caffeinated coffee is not associated with a substantial increase in risk. But
if people have hypertension, and are having a hard time controlling their
hypertension, they could try switching from caffeinated coffee to decaffeinated
coffee, to see if it has a beneficial effect.

With
diabetes, it’s a bit of a paradox. Studies around the world consistently show
that high consumption of caffeinated or decaffeinated coffee is associated with
low risk of type 2 diabetes. But if you look at acute studies that just give
people caffeine or caffeinated coffee, and then have them eat something rich in
glucose, their sensitivity to insulin drops and their blood glucose levels are
higher than expected.

There
isn’t any long-term data on coffee consumption and glucose control. But if
people have diabetes and have trouble controlling their blood glucose, it may
be beneficial for them to try switching from caffeinated to decaffeinated
coffee. Making the switch from caffeinated to decaf may be better than quitting
coffee altogether, because some research suggests that decaffeinated coffee
actually reduces the glucose response. Much more information on this topic can
also be found at this website: http://www.hsph.harvard.edu/nutritionsource/coffee/
.

According
to the Mayo Clinic,
studies have shown that coffee may have health benefits,
including protecting against Parkinson’s disease, type 2 diabetes (as noted by
the Harvard information) and liver disease, including liver cancer. It also
appears to improve cognitive function and decrease the risk of depression.
However, the research appears to bear out some risks.

High
consumption of unfiltered coffee (boiled or espresso) has been associated with
mild elevations in cholesterol levels. And some studies found that two or more
cups of coffee a day can increase the risk of heart disease in people with a
specific — and fairly common — genetic mutation that slows the breakdown of
caffeine in the body. So, how quickly you metabolize coffee may affect your
health risk.

 

Coffee is
actually very healthy, according to Authority Nutrition.  It is loaded with antioxidants and beneficial
nutrients that can improve your health. For thirteen very good health reasons
why you should drink coffee, visit this website: http://authoritynutrition.com/top-13-evidence-based-health-benefits-of-coffee/
.
In fact, there are many advantages to being one of the 54 percent of Americans over 18 who drink coffee every day.
Coffee can be pretty amazing for your brain, your skin, and your body.

 

How To Challenge Health Care Corruption Under a Corrupt Regime?

Introduction: the Corruption of Health Care Leadership as a Major Cause of Health Care Dysfunction

For a long time we have argued that health care corruption is a major cause of health care dysfunction.  As we wrote in August, 2017, Transparency International (TI) defines corruption as

Abuse of entrusted power for private gain

In 2006, TI published a report
on health care corruption, which asserted that corruption is widespread
throughout the world, serious, and causes severe harm to patients and
society.

the scale of corruption is vast in both rich and poor countries.

Also,

Corruption might mean the difference between life and death for
those in need of urgent care. It is invariably the poor in society who
are affected most by corruption because they often cannot afford bribes
or private health care. But corruption in the richest parts of the world
also has its costs.

The report got little attention.  Health care corruption
has been nearly a taboo topic in the US, anechoic, presumably because its discussion would offend the people it makes rich and powerful. As suggested by the recent Transparency International report on corruption in the pharmaceutical industry,

However, strong control over key processes combined with huge resources
and big profits to be made make the pharmaceutical industry particularly
vulnerable to corruption. Pharmaceutical companies have the
opportunity to use their influence and resources to exploit weak
governance structures and divert policy and institutions away from
public health
objectives and towards their own profit maximising interests.

Presumably the leaders of other kinds of corrupt organizations can do the same. 

When health care corruption
is discussed in English speaking developed countries, it is almost
always in terms of a problem that affects somewhere else, mainly  presumably benighted less developed
countries.  At best, the corruption in developed countries that gets discussed is at low levels. 
In the US, frequent examples are the “pill mills”  and various cheating of
government and private insurance programs by practitioners and patients.  Lately these have gotten even more attention as they are decried as a cause of the narcotics (opioids) crisis (e.g., look here).  In contrast, the US government has been less inclined to address the
activities of the leaders of the pharmaceutical companies who have
pushed legal narcotics (e.g., see this post). 

However, Health Care Renewal has stressed “grand corruption,” or the
corruption of health care leaders.  We have noted the continuing impunity of top health care corporate managers.  Health care corporations have allegedly used kickbacks and fraud to enhance their revenue, but at best such corporations have been able to make legal settlements
that result in fines that small relative to their  multi-billion
revenues without admitting guilt.  Almost never are top corporate
managers subject to any negative consequences.

While we at Health Care Renewal have written about this for years, we saw little improvement.  However, in the past few years we began to feel a little more encouraged.  For example, we had long complained that US law enforcement had not been devoting enough effort going after the corruption of the leadership of large health care organizations, thus effectively allowing these leaders’ impunity. However, the US Department of Justice during the Obama administration made some
modest attempts to decrease such impunity.  One such measure was the
formation of a Health Care Corporate Strike Force.

As reported by Law.com,

the strike force was created in the fall of 2015, with five dedicated
lawyers working on about a dozen of the most complex corporate fraud
cases in the health care space.

Andrew Weissmann, the then-chief of the DOJ’s fraud section, told a
health care conference in April 2016 that the section was placing ‘a heightened emphasis’ on corporate health care fraud investigations.
He pointed to the recently established Corporate Fraud Strike Force
that he said would focus resources in investigation and prosecution of
larger corporate health care law violations, as opposed to smaller
groups or individuals.

Unfortunately, that strike force was downsized by the Trump administration as we noted in July, 2017.  Perhaps that could have been viewed as just a minor setback.

Yet as the year wore on, it became obvious that the corruption was becoming an even bigger problem.  In fact, it was becoming even more systemic, and worse, it appeared that the administration itself was fundamentally corrupt.

The Systemic Corruption of the Trump Regime

In December, 2017, the Los Angeles Times published a list by Adam Johnson of the “top 10 under-coverd news stories of 2017.”  His third entry was:

3. President Trump’s unprecedented non-Russia corruption

Time will tell the extent of President Trump’s connection to Russian officials and how it may or may not have influenced his campaign but — regardless — Trump has led the most nakedly corrupt administration in modern American history, enriching himself, his family and his friends and hiring a Cabinet of political cronies and billionaires. Many journalists have done great work revealing this corruption, but these stories have not turned into full-blown scandals, let alone harmed the president.

The article used as a source a website, entitled “Tracking Trump’s Conflicts of Interest” published by the Sunlight Foundation.  It includes a spreadsheet of literally hundreds of conflicts.

In January, 2018, Washingon Monthly published two related articles on President Trump’s conflicts of interest and corruption.  The first was “Commander-in-Thief,” which categorized Mr Trump’s conflicted and corrupt behavior.  The second, “A Year in Trump Corruption,” was a catalog of the most salient cases in these categories in 2017.

Commander-In-Thief opened with this explanation,

official Washington has tolerated an entire other class of corrupt and potentially unconstitutional behavior being carried out in plain sight, as Trump uses the presidency to enrich himself and his family. He has installed immediate relatives at the helm of the Trump Organization, continued to accept payments from foreign governments and private interests, and lavishly billed the government for using his own properties—all without guaranteeing that he will prioritize his duties as president over his own bottom line.

No president ever entered office with the type of immense personal fortune and ongoing business interests that Trump has. Trump’s vast business empire spans more than 500 companies in twenty-five countries and has earned him an estimated net worth of $3.1 billion. Traditionally, on taking office, presidents have placed their assets in a “blind trust” whose trustee is legally barred from telling the beneficiary about the trust’s holdings. Jimmy Carter famously placed the family peanut business into a blind trust in 1977. Ronald Reagan, George H. W. Bush, Bill Clinton, and George W. Bush all followed suit.

Trump’s trust agreement is a little different. For one thing, it’s not blind—Trump’s children have admitted to providing their father with regular business updates. For another, the agreement allows him to withdraw profits and assets from the trust at any time. That means Trump has a direct and ongoing financial interest in any policy decision that could affect his businesses.

Much of this has happened in broad daylight. The mainstream media has covered Trump’s conflicts doggedly. But the steady drip-drip-drip of evidence hasn’t captured the public’s attention like Russia has, or motivated any serious response by the government—no investigations are under way, either in Congress or the executive branch. This despite the fact that the infractions raise the same terrifying possibility as Trump’s possible collusion with Russia: the sacrificing of American interests in the service of the president’s personal gain.

[the Trump Chicago, an example of Mr Trump’s vast business empire]

The article noted that at the time of publication,

The only active effort to investigate Trump’s profiteering is happening through civil lawsuits in New York, D.C., and Maryland federal courts. The plaintiffs challenging Trump’s behavior include the watchdog group Citizens for Responsibility and Ethics in Washington (CREW); some 200 Democrats in Congress, led by Connecticut Senator Richard Blumenthal; attorneys general in Washington, D.C., and Maryland; and hotel and restaurant owners who compete with Trump. They all argue that Trump is in blatant violation of a provision in the Constitution meant to ensure that the president can’t exploit his office for profit.

Note that since those articles were written, Democrats in the House of Representatives have called for a serious investigation by the House Oversight Committee of how the Trump Organization is exploiting his presidency for financial gain, although the likelihood that their political opponents would condone such an investigation seems small (look here).

The article posited that Mr Trump’s corrupt activities fit into three categories.

Corruption Type 1: Foreign Emoluments

Mr Trump appears to be benefiting from payments or the equivalent from foreign governments, an apparent violation of the Foreign Emoluments Clause of the US Constitution.

Foreign interference in our political system was of grave concern to the framers of the Constitution. They knew that when a federal officeholder receives gifts, money, or other benefits from foreign governments, his judgment is compromised and his loyalties are divided. So they wrote a strict rule into the text of the Constitution, the Foreign Emoluments Clause, which provides that federal officeholders may not ‘accept of any present, emolument, office, or title, of any kind whatever, from any king, prince, or foreign state’ without Congress’s approval.

Unlike with bribery statutes, a violation of the Foreign Emoluments Clause doesn’t require proof that an official gave something in return. It’s designed to protect against not just quid pro quo corruption, but also the mere appearance of improper influence on government officials.

Note that the Constitution also provides that

Before he enter on the Execution of his Office, he shall take the following Oath or Affirmation: — ‘I do solemnly swear (or affirm) that I will faithfully execute the Office of President of the United States, and will to the best of my Ability, preserve, protect and defend the Constitution of the United States.’

So any presidential violation of the Foreign Emoluments clause is also an example of what we have previously called mission-hostile management.

The Foreign Emoluments clause is basically a prohibition of a
particular kind of conflict of interest, payments to the President by
foreign leaders or states. However, many examples of violations of this clause by Mr Trump also suggest corruption. “Commander-in-Thief” describes

foreign governments’ lavish spending at Trump’s hotel and restaurants, particularly at the Trump International Hotel just steps away from the White House, in some cases at the prodding of Trump’s agents. After the election, the Trump International hosted more than 100 foreign diplomats for a tour, sending them home with goody bags and brochures in an attempt to encourage their patronage. Former Mexican diplomat Arturo Sarukhan has said that the State Department urged diplomats to stay at the Trump International while on official visits.

Delegations from at least eight countries have obliged. In September, Malaysian Prime Minister Najib Razak and other members of his administration were seen hobnobbing in meeting rooms at the hotel, bringing in what is estimated to be hundreds of thousands of dollars in revenue. Saudi Arabia has spent more than a quarter of a million dollars—$190,000 on lodging, $78,000 on catering, and $1,600 on parking—at the hotel in connection with its lobbying against legislation that would allow American citizens to sue foreign governments over terrorist attacks.

And the Kuwaiti embassy suddenly changed the venue for its National Day celebration last February from the Four Seasons to the Trump International, paying an estimated $40,000 to $60,000. A source with knowledge of the conversations between the hotel and the embassy told ThinkProgress that Trump Organization members had pressured the Kuwaiti ambassador to cancel the embassy’s ‘save the date’ reservation at the Four Seasons, where it had held the event in the past. Perhaps it’s purely a coincidence that neither Saudi Arabia nor Kuwait were among the Muslim-majority nations singled out by Trump’s travel ban.

[Trump International Hotel, Washington, DC]

Recall the Transparency International definition of corruption, abuse of entrusted power for private gain.  That the Trump Organization, owned mainly by Mr Trump, and likely still run according to his wishes by his children, actively promoted foreign governments pay for overpriced hospitality services which would directly profit Mr Trump.  Given that Mr Trump is supposed to lead foreign policy in the interests of all US citizens and according to the US Constitution, this seems to be a gross example of abuse of entrusted power, and is obviously for private gain.

“Commander-in-Chief” listed various other examples of violations of the Foreign Emoluments clause.  Moreover, the companion article, “A Year in Trump Corruption,” listed pages of examples of the more prominent known violations, starting with the case of the 100 foreign diplomats above, and ending with

Oct. 31, 2017: Mexico’s former U.S. ambassador Arturo Sarukhan tweets that the State Department is encouraging diplomats to stay at the Trump International Hotel during official visits.

Corruption Type 2: Domestic Emoluments

Mr Trump appears to be directly benefiting from payments made by the US government, in violation of the Domestic Emoluments Clause.  Per “Commander-in-Thief,” 

The framers weren’t just worried about foreign influences. They intended the Domestic Emoluments Clause to ensure that Congress, other parts of the federal government, and the states ‘can neither weaken [the president’s] fortitude by operating on his necessities, nor corrupt his integrity by appealing to his avarice,’ as Alexander Hamilton wrote in the Federalist Papers. It entitles the president to receive a salary (currently $400,000 a year) and benefits fixed by Congress, but prohibits him from taking any other profits from the public—whether from the federal government or from any of the states.

Trump violates this provision, many constitutional scholars have argued, when state or federal entities patronize his properties and spend taxpayer money.

Again, this provision also prohibits a certain kind of conflict of interest, that produced were a president to personally profit from activities of the US or state governments.

One sort of example the article provided was

Trump doesn’t just rely on others to put money into his businesses—he patronizes them himself with stunning frequency, having spent more than 100 days at them, nearly a third of his presidency, while in office. Unlike any previous president, Trump’s vacation properties are for-profit enterprises, meaning each visit funnels public money to Trump’s business, mainly in the form of exorbitant security costs. Secret Service has blown through its budget due to Trump’s frequent travel expenses, requesting an additional $60 million to protect the first family in March. Trump’s detail reportedly paid Mar-a-Lago, Trump’s luxury club in Palm Beach, Florida, at least $63,000 between February and April, and has spent at least $144,975 on golf cart rentals at Trump properties in New Jersey, Virginia, and Palm Beach as of November. And last spring, the Defense Department signed a $2.39 million eighteen-month lease for space in Trump Tower for a military office meant to provide various presidential services, including access to nuclear launch codes.

In this example, Mr Trump’s personal decisions, for example to vacation at one of his own properties, automatically entail major expenses by the government he is supposed to lead.  These these USG government expenses thus become revenues for none other than Mr Trump.  Again, it seems easy to argue that such decisions are abuse of entrusted power for private gain.

Again, the companion article listed multiple other examples, beginning with

Nov. 14, 2016: Six days after the election, Trump receives all-but final approval from the National Park Service for a $32 million historic preservation tax credit for the Trump International Hotel.

And ending with:

Nov. 15, 2017: USA Today reports that, thanks to Trump’s refusal to divest from his businesses, the federal government has assigned at least 10 Justice Department lawyers and paralegals, at salaries ranging between $133,000 to $185,000 in public money, to defend Trump in four lawsuits alleging violations of the Emoluments Clause.

Corruption Type 3: Slimy, but Probably Legal

Mr Trump has also taken advantage of his office to increase revenues to the Trump Organization, which he owns.  Per “Commander-in-Thief,”

Many presidents have been independently wealthy, but none before Trump entered the White House with a massive on-going business empire—or brazenly used the office to drive up that empire’s value.

Some examples given were

Almost immediately following his inauguration, the annual membership rate at Mar-a-Lago, which Trump has dubbed his ‘Winter White House,’ doubled, from $100,000 to $200,000, reflecting Trump’s eagerness to capitalize on the market value of access to the leader of the free world. In February, Mar-a-Lago management sold a tennis shirt featuring a ’45’ on the sleeve in reference to Trump, the forty-fifth president. By April, rates at the Trump International Hotel had jumped to at least $660 per night, an increase in hundreds from before his election. And in November, the president plugged his New Jersey golf course during a foreign policy speech in Seoul.

The companion article again listed numerous examples, starting with the increase in the Mar-a-Lago membership rate, and after examples involving Mr Trump’s Trump International Hotel in Washington, DC, and various other Trump resort and hotel properties, ending with:

Dec. 31, 2017: Trump ends 2017 the way he started it: with a private gala at Mar-a-Lago. This time, tickets are up to $600 for club members and $750 for guests.

Again, given that these cases involved the president trading on his office and the advantages of gaining personal access to him to increase revenues at the hospitality properties he owns, it seems easy to argue that they involved abuse of entrusted power for private gain.

Summary

In the rare instances in which health care corruption has been discussed publicly, one sometimes sees ideas about addressing corruption affecting various health care organizations.  For example, in October, 2016, Transparency International announced its Pharmaceuticals & Healthcare Programme, based in the UK. It would

target global, national and local interventions. Ongoing research and the lessons drawn from regional and national projects will be used to influence global policy to produce structural change within the health sector; promote global best practice standards to strengthen transparency and accountability; and support national and local interventions and solutions.

That is all well and good, and will hopefully lead to some improvements globally.  But such recommendations are based on tacit assumptions, particularly that well-intentioned governments will at least consider such changes in policy.

We in the US are now in a different situation. In an interview published by Vox, historian Robert Dallek said,

Often you see a lot of corruption result from a lack of oversight, but I think this administration is quite different in that Trump really sets the tone for all this. He encourages it, really. The fish rots from the head, and the stench of this administration starts at the very top.

IMHO, when the fish is rotting from the head, it makes little sense to try to clean up minor problems halfway towards the tail.  It would be silly to expect that the Trump regime would want to “produce structural change within the health sector; promote global best practice standards to strengthen transparency and accountability; and support n ational and local interventions and solutions” all to reduce corruption in health care.  Why would a corrupt regime led by a president who is actively benefiting from corruption act to reduce corruption?

The only way we can now address health care corruption is to excise the corruption at the heart of our government.

Lung Cancer Part 3 – Rx with Surgery and/or Radiation



Surgery
has long been the only way to cure lung cancer. If the tumor was discovered
early – a rare occurrence in the past – then resection could remove it totally.
Recently it has been shown that radiation can be used successfully for early
stage disease. And new approaches to radiation therapy result in the ability to
give higher doses to the tumor, limit damage to surrounding normal lung and do
so with relatively few sessions under the machine.

Thus far in this five part series
has been a general discussion of lung cancer facts and figures followed by
controlled enthusiasm about early diagnosis using CT scanning. The treatment of
lung cancer has also progressed dramatically and with early diagnosis as a
result of CT scanning high risk individuals, it is now possible to cure a
larger proportion of patients.

Today an increasing number of
individuals are having their cancer detected early so curative approaches will
become more common. But many if not most lung cancer patients are older and
have either chronic lung disease, heart disease or both, rendering them at
higher risk for surgery. At a minimum the surgeon wants to do as limited a
procedure as possible, using the least invasive approach. Still, not all
patients are good surgical risks.

Despite finding the cancer when it
is still small and with no apparent evidence of spread, many patients still
relapse in a few months or years after surgery. The addition of chemotherapy to
treat microscopic but undetected disease has a resulted in improved cure rates.
The same approach is being used for those treated with radiation of early stage
lung cancer.

Until recently, it was assumed that
only surgical resection could cure small early stage lung cancer. But many
patients are poor surgical candidates due to age, chronic lung disease, heart
disease or other concomitant conditions. The question thus arises, could these
newer approaches to radiation therapy be as effective.  Multicenter trials have now demonstrated that
stereotactic body radiation treatment (SBRT) appears equivalent to surgery in
terms of the local control of the tumor in small (

It is important to understand that
radiation can destroy any cancer if sufficient radiation can be applied. For
many cancers, however, the risk of damage to adjacent normal tissues that are
essential for life (e.g., normal lung) makes it impossible to give the desired
dose. That said, radiation oncology has advanced dramatically in the past
decade and the rate of progress is increasing rapidly. Innovations as a result
of engineering and computer advances along with conceptual advances are making
a dramatic difference. Major advances in radiation therapy mean greater
effectiveness, fewer side effects and less time in treatment.

Newer devices allow stereotactic
treatment not only for stationary tumors but also lung cancers– overcoming the
problem of motion caused by breathing or even heartbeat and blood flow. The
combination of continuous imaging, motion detection and robotic guidance
combine to allow much more effective treatment than in just the very recent past.

Stereotactic body radiation
treatment appears to be a very useful new approach to many otherwise difficult
to treat cancers such as in the lung. It begins with the use of earlier
techniques where the cancer is treated from multiple angles such that the tumor
receives a large dose but the adjacent normal tissues receive much less. Stereotactic
means that the tumor is imaged and the radiation adjusted to directly attack
the cancer and not the normal tissue. A related innovation is to link actual
delivery of radiation with the patient’s breathing parameters (gating). This is
done with an infrared device that observes motion and turns the radiation beam
on and off during the breathing cycle. This can be of great value in lung
cancer because the target is constantly moving. This greatly reduces normal
tissue damage occurring as the lungs move with respiration. It also means that
the cancer gets a higher dose because the physician is less encumbered by a
concern for damaging adjacent normal lung. This is a real improvement as in the
past it was necessary to curtail the ideal dose with the realization that that
dose would cause unacceptable side effects on adjacent normal tissue.

Hypofractionation, that is giving a
much higher dose of radiation per session, with the much greater accuracy of
the stereotaxic approach, means many fewer sessions yet with high effectiveness.
Much SBRT is now done in 3-5 fractions rather than the more typical approach of
multiple, perhaps as many as 45, fractions over as many days or more. Add
robotic guidance based on motion detection and the combination becomes very
powerful. With robotic control of the equipment from outside the treatment
room, this means less time is wasted by the staff moving back and forth to make
adjustments and less time on the table for the patient. 

Most radiation today is delivered
by X-rays or electrons (photons). Another approach is to use protons. Proton
beam therapy has the advantage that the proton gives up its energy only when it
hits its intended target – in this case the tumor. It does not continue through
the tumor and damage normal cells on the far side. So it allows for the
delivery of very high doses of radiation to the tumor with minimal side
effects. It follows that proton beam might prove very useful because one can
give a much higher dose without as much fear of adjacent normal tissue damage.
But it is critical to keep in mind that there are no controlled studies showing
superiority of protons over photons and certainly none in lung cancer as of
yet. As a result it is important that the clinical value of proton beam therapy
not be over inflated. The cost of one center runs into the hundreds of millions
of dollars — which would purchase 20 or more photon linear accelerators.

What is clear is there is a steady
and rapid, advance in the ability to deliver radiation therapy to those with
lung cancers in a more effective and more safe manner, often in much less time
than in the past. The realization that radiation can actually be used to cure
early stage lung cancer is a stunning advance, allowing effective treatment for
those not able to undergo surgery.

In the next of this series will be
a discussion of the dramatic advances in lung cancer treatment with drug
therapy.

3cm>

Navy Investigates Murtha’s Death – CNN’s Elizabeth Cohen Reports Unhelpful Advice

Nine days after my post wondering if the late Rep. John Murtha’s death after an elective gallbladder surgery was a result of a preventable medical error, CNN and the Washington Post report that the Navy is now opening an investigation.

“The review is being conducted to determine if Murtha died due to a preventable surgical error and whether any action against those who performed the surgery is potentially warranted.” according to the CNN article.

While this is good news, what I found rather disappointing was CNN’s senior medical correspondent Elizabeth Cohen thoughts on how Murtha might have acted differently to avoid this unforseen outcome.

“You really have to be an aware and empowered patient because in those two days it’s likely that he likely felt something that he felt some discomfort or felt a bit ill and, of course, we aren’t trying to blame the patient but if you feel anything at all strange following a surgery you have to go back to that surgeon.”

While I suspect she is trying to be helpful, the advice she offers isn’t particularly meaningful. Who doesn’t feel a little discomfort, feel strange, or a bit ill after having surgery? What other past life experience provides a reference point on whether this post-operative recovery will turn out fine or be completely disastrous?

The reason she would say such a thing is because our healthcare system is not as good as it must be in preventing medical errors and eliminating missed opportunities for prevention and screenings. Patients don’t want to constantly worry about being an “aware and empowered patient”. They don’t want to be burdened with the responsibility of being vigilant for bad outcomes. They would rather can focus on healing and getting better.

Our healthcare system must continue to focus on improving patient safety.

So, in the end, was Murtha’s death preventable? While I don’t have any specifics of his case, my sense is that unfortunately his death was the result of a known risk and surgical complication and not due to gross incompetence or negligence. Let’s be frank the Navy’s review of Murtha’s death is only because of his status as a very visible Congressman. Had this occurred to someone else, I doubt a death after gallbladder surgery would have received this level of scrutiny.

If this review is done objectively, then I don’t expect anyone to be reprimanded or fired.

His death, however, does serve as important reminder. Only have surgery if it is absolutely necessary.

Are Taller People at Heightened Cancer Risk?

(HealthDay News) — Tall folks may be more likely than shorter people to develop cancer, new British research says.

Among women, the risk of breast, ovarian, uterine and bowel cancer, leukemia or melanoma appears to go up about 16 percent for every 4-inch bump in stature, the researchers said.

“Taller women in our study had increased risk of a wide range of cancers,” said study co-author Jane Green, from the cancer epidemiology unit at the University of Oxford in England. “And all the evidence from past studies is that this link is seen equally in men and women.”

The findings also suggest that gains in height over the 20th century — Europeans’ average height grew nearly half an inch per decade — might help explain some of the cancer differences seen in recent generations, the researchers said. Read more…

Ayurtox for Body Detoxification

Liposuction

What is Liposuction ?

Liposuction, also known as lipoplasty (“fat modeling”), liposculpture or suction lipectomy (“suction-assisted fat removal”) is a cosmetic surgery operation that removes fat from many different sites on the human body. Areas affected can range from the abdomen, thighs, buttocks, to the neck, backs of the arms and elsewhere. The fat is usually removed via a cannula (a hollow tube) and aspirator (a suction device).

As with any surgery, with Liposuction, there are certain risks, beyond the temporary and minor side effects. The surgeon may mention them during a consultation. Not everybody is a good candidate for liposuction. Infact, it is not a good alternative to dieting or exercising. To be a good candidate, one must be:

* Over 18

* In good general health

* Have tried a diet and exercise regime, and find that the last 10 or 15 pounds persist in certain pockets on the body.

Diabetes, any infection, or heart or circulation problems usually nullify one’s eligibility for the procedure.

Facial Liposuction

Facial liposuction removes excess fatty tissue in the face. The surgeon performing the facial liposuction uses a special tube (cannula) inserted in an inconspicuous location on the face or neck. Facial liposuction procedures, like other liposuction procedures, use suction to remove fat from under the skin.

Abdominal Liposuction

During abdominal liposuction, the surgeon makes a tiny incision in the skin, typically in the navel or just below the bikini line, and inserts a cannula into the fatty area. The cannula is used to break up the fat deposits and sculpt the area to the desired proportions. The unwanted fat is removed with a powerful vacuum, leaving the skin, muscles, nerves, and blood vessels intact.

Neck Liposuction

During the Neck Liposuction procedure, the surgeon makes a tiny incision in the skin, typically in the crease just under the chin or behind the ear lobes. He/she next inserts a thin tube called a cannula into the fatty area. The cannula is used to break up the fat deposits and sculpt the area to the desired proportions. The unwanted fat is removed with a high pressure vacuum, leaving the skin, muscles, nerves, and blood vessels intact.

Thigh Liposuction

Precise areas are marked and general anaestasia or sedatives may be given.During the procedure, the doctor makes a tiny incision in the skin, typically in or near the buttock crease or at the site of a previous scar, and inserts a thin tube called a cannula into the fatty area. The cannula is used to break up the fat deposits and sculpt the area to the desired proportions. The unwanted fat is removed with a high pressure vacuum, leaving the skin, muscles, nerves, and blood vessels intact.

Liposuction Prices

Factors that determine Liposuction Cost include:
1) The size of the patient
2) Amount of time and effort required of the surgeon
3) Cost of anesthesiologist’s services
4) Operating room fees
5) Preoperative laboratory fees
6) Other related expenses, such as elastic compression garments, etc.

Here are some tentative prices listed for Liposuction:

Table of Approximate Surgical Fees in the United States of America
Body Area Approx Lower End Surgical Fee ($)Approx Upper End Surgical Fee ($)
Abdomen, upper & lower 3,000 7,500
Abdomen, lower 2,000 2,000
Arms 1,500 5,000
Back, female 1,500 4,000
Breasts, female 3,000 7,500
Breasts, male 3,000 5,000
Buttocks 1,500 4,500
Chin, Cheeks, Jowls, Neck 2,000 4,500
Flanks, male 2,000 5,000
Anterior Thighs & Knees 2,000 5,000
Inner (Thighs & Knees) 2,000 5,000
Hips/Waist 1,600 5,000
Outer Thighs 1,600 5,000
(Total fee = All Surgical Fees + Non-Surgical Fee). If an anesthesiologist is required, then an additional fee must be anticipated