This item comes as no surprise to those of us who primarily treat the elderly.

According to researchers, nearly 100,000 hospitalizations every year are linked to adverse drug events such as allergic reactions and unintentional overdoses. Nearly half, or 48.1 percent, of those hospitalized were adults 80 years old or older.

Those agents? Insulin, older generation anti-diabetic drugs (oral), aspirin, and warfarin. It is quite true — and as equally disturbing — that these medications are not only responsible for discrete adverse drug reactions in their own right, but their pharmacological behaviors are responsible for a substantial number of interactions whose iterative clinical manifestations are truly logarithmic in scope. | LINK | Abstract LINK

Related posts:

1. UK Study: Drugs Used in Alzheimer Patients Double Risk of Mortality What should I do as a physician rounding on one...
2. CDC: Pharmacies Offering No-Cost Antibiotics Should Promote Responsible Use Smaller chain pharmacies are trying to compete with the big...
3. Physicians Tackle So-Called ‘Heavy Utilizers’ to Control Acute Care Costs A pretty interesting piece on the role some hospitals are...

We’ve all seen the numbers, forever etched in the tableaus of talking points on each side of the healthcare debate in this country; and they continue to be staggering. The total of uninsured in the United States is now approaching 60M,^[1] as of mid-2010. Throughout the 2000s healthcare policy watchers have seen a healthy and smooth trajectory upward of almost 20M since the late 1990s and the boomtimes of for-profit managed care. Within the scope of reform, the numbers are bad enough; but in a presidential administration beset with certain gridlock (between legislative and executive branches) come January, the newly released figures from the CDC do not bode well for ideas of reform on either side of the ideological aisle.

That’s because the data do not lie. For the first time, there is a significant jump in the number of uninsured who live well north of the poverty line, according to the CDC. Half of the uninsured are comprised of those who live above the poverty level, and the personal incomes of one in three adults under 65 rest comfortably in the middle income range — defined by the feds as being between $44,000 and $65,000/year for a family of four.

Also, much has been said about only the healthy going without some form of healthcare coverage. According to the CDC, however, more than 40 percent of those uninsured at some point during 2010 had at least one chronic disease. When one factors in the definition of “chronic disease” as disorders such as diabetes and asthma, alongside the prevalence rates of such disorders, it is not difficult to envision a deepening healthcare delivery crisis post-reform. With the new Congress taking a hardline on healthcare financing and the definition of reform certain to change, these numbers cannot be ignored. In fact, they demand reconsideration of the costs of covering the uninsured.  | LINK

1. Per the CDC — In the first quarter of 2010, the estimated number of persons without coverage for at least part of the year increased by 400,000 (0.7%), from 2009 to 59.1 million. The number of persons aged 18–64 years without coverage for at least part of the year increased by 1.3 million (2.7%) to 49.9 million, and the number without coverage for more than a year increased by 1.3 million (4.5%) to 30.4 million.

Related posts:

1. Many Uninsured in Illinois to Apply for Coverage During Transition under Reform Illinois will offer this week the first-in-the-nation coverage plan for...
2. Top Ten DP Posts for 2010 (Nos. 7-5) For the eight hundredth (!) post on Doctor Pundit, here...
3. States Look for Ways to Combat Imminent Medicaid Costs at Dawn of Reform Some states are using the issue as a campaign 2012...

Year in and year out, it seems as though we’re greeted with the same news from health organizations: that the worldwide data on HIV/AIDS infection rates and treatments could not be more disparate. We keep hearing about the fact that, although awareness is at an all-time high, outreach to the world’s most affected populations continues to struggle. Two thousand nine/2010 are no different. This year, only a third of treatable persons worldwide are actually being treated.^[1] That’s in spite of the fact that world leaders have pledged no narrow that gap, time and time again.

What about on these shores? Two days ago, the U.S. recognized National Gay Men’s Awareness Day. There is no doubt that a major increase in awareness in this country since the late 1980s has brought forth some of the world’s greatest pharmacological achievements in the fight against this dreaded infection. But, there is no escaping the fact that the celebration of 9/27 itself because of these achievements — was eclipsed by one startling statistic: that nearly half of all gay men do not know that they are infected with HIV. The nature of the infection, although constantly changing and being researched, is clearly well known. Perhaps education — or lack of it — about HIV as a sexually transmitted infection needs a re-examination itself. Perhaps, there is still a stigma attached to the relay of that information to the most appropriate points of contact: from the provider to the patient. Or, maybe, its the overconcern of the lifetime cost of care for someone infected with HIV.

All of these reasons (and probably many more too numerous to mention) are valid ones to consider as we pass yet another milestone in the history of HIV/AIDS, and the strategy to make this infection entirely preventable becomes more important than ever. | LINK

1. This is mainly true due to WHO recommendations to start treatments at earlier ages.

Related posts:

1. Access of Indigent to HIV/AIDS Service Delivery Threatened in Weak Economy Needy HIV+ patients a victim of the economic recession? With...
2. CDC: Explosion of Uninsured in 2010 Underscores Need for ‘Continuous Coverage’ to Control Costs Associated with Overutilization We’ve all seen the numbers, forever etched in the tableaus...
3. Top Ten DP Posts for 2010 (Nos. 7-5) For the eight hundredth (!) post on Doctor Pundit, here...

It can identify tuberculosis in 2 hours. That’s a far cry from a current modality which takes at least 2 days to even screen for. The latest advance in the war against TB — thought to have been largely won in the latter quarter of the 20th century — can now be characterized by a rapid assay said to be more than 97 percent accurate and is even able to diagnose drug-resistant TB. Current testing involves the use of a microscope and is prone to investigator error and poorly obtained samples — something that can result in a missed diagnosis at alarmingly high rates. In endemic areas of the globe, that inconsistency is, of course, problematic.

As a result, TB is able to be identified in one single office visit. TB is a chronic bacterial infection spread through the air and usually infects the lungs, although other organs of the body can be involved. Most people who are infected with tuberculosis bacterium (Mycobacterium tuberculosis) don’t have symptoms, but some will develop the disease. Around 2 billion people — one-third of the world’s population — are thought to be infected with M. tb. The World Health Organization estimates that 8 million people develop active TB each year and nearly 2 million die. The test will be up for FDA approval and is already available in Europe. | LINK

Related posts:

1. Future Diabetes Care Costs Present Major Problem, Even with Reform Diabetes may be known for other things than just a...
2. Research Trends Positively Influence Approach to Alzheimer Dementia Research into better treatments and possible cures of Alzheimer dementia...
3. Groups: Mandatory Yearly Influenza Vaccine for All Healthcare Workers The huge drive to immunize the masses against threat of...

The huge drive to immunize the masses against threat of H1N1 in the 2009/10 influenza season (which the WHO has officially declared concluded) has created more than a watershed moment in 21st century public health response to a potential biological catastrophe, it has also touched off a political debate that’s just getting started. And it all has to do with authoritarian mandate of the vaccine for healthcare workers.

Contrary to popular thought, many healthcare workers do not receive the vaccine; in fact, approximately 40 percent of said workers actively refused [PDF link] the vaccine last year — during infection’s peak. This notion does not sit well with a couple of policy organizations — one academic and one medical. Both groups say mandatory influenza vaccine should be a condition of employment. The groups stress increased availability of the vaccine, a steadier supply of healthy workers to administer care in times of a crisis, and an overall decrease in the incidence of influenza-related deaths in already compromised inpatients with other medical problems.

Already, the state of New York is hard at work in developing regulatory actions for its public healthcare workers. | LINK

Related posts:

1. Monday Newswire: MN’s First Influenza-A Case & More NY state recoups over half a billion dollars in amounts...
2. German Government Critic Alleges WHO Exaggeration of H1N1 Threat, Cites Oversupply of Vaccine Given time, anything can be politicized. Take the hysteria surrounding...
3. Report: Pharma Amplified Global H1N1 Scare What is known about the H1N1 epidemic that plagued the...

Just how effective are vaccines at keeping mass pandemics of infectious disease abated? Well, it may not be so easy to estimate.

[T]he number of annual flu-related deaths in the United States has ranged from a low of about 3,300 to a high of about 49,000. This is a revision of the static estimate of 36,000 annual deaths that has been reported consistently for years by the U.S. Centers for Disease Control and Prevention.

The CDC has revised its projections on the preventive care of the seasonal influenza vaccine, moving from statistical dead targets to ranges of mortality among influenza outbreak figures. Its projections cover most of the past 30 years (up to 2007, and not inclusive of last year’s H1N1 pandemic). | PDF  LINK to latest issue of CDC’s Morbidity & Mortality Weekly

Related posts:

1. Monday Newswire: MN’s First Influenza-A Case & More NY state recoups over half a billion dollars in amounts...
2. When Patient Activism Becomes Problematic for Physicians The battlelines are drawn in the latest medicolegal war which...
3. NEJM Updates Website for 21st Century Medical Education The New England Journal of Medicine, long a standard in...

The questions and lingering concerns surrounding the overuse of antibiotics is an age-old and well-worn conundrum for physicians and patients. Even the latter group, well-informed as consumers of healthcare, can agree that most acute upper respiratory infections are most often the result of viral infestations which play themselves out in spite of antimicrobial treatment.The decision to (over)use them in standard medical practice is often the point of debate, as physicians weigh factors such as patient satisfaction and lingering medical and health policy issues surrounding resistance.

Last year, this blog reported on these issues as background for a program in which some retail pharmacy chains were giving away for free antibiotics to patients with prescriptions from their physicians as a way of helping with affordability in the wake of the debate on reform. The CDC offered a statement promoting the responsibilities providers, pharmacists, and patients should consider in taking part in such a program.

Smaller chain pharmacies are trying to compete with the big boys, and in trying to earn store-brand loyalty among their (un- and underinsured) consumers, they are throwing free antiobiotics their way. Last week, the CDC sent out letters those several chain pharmacies that offer no-cost prescription antibiotics to low-income consumers urging them to promote responsible use of antibiotics.

While the program was essentially successful in its efforts to bridge the gap between affordable, accessible healthcare and patient responsibility, no one was really prepared for the massive policy decisions that would have to be made as the June ’09 H1N1 pandemic loomed — after its initial discovery just one month after this initial Doctor Pundit posting.

Related posts:

1. CDC: Pharmacies Offering No-Cost Antibiotics Should Promote Responsible Use Smaller chain pharmacies are trying to compete with the big...
2. Patient Advocacy Group on Prostate Cancer Gets Serious about Prevention – Zero prostate cancer deaths. Zero prostate cancer cases and for...
3. When Patient Activism Becomes Problematic for Physicians The battlelines are drawn in the latest medicolegal war which...

It’s often said that the beleaguered emergency department (ED) is the initial point of care for many patients. In this current broken healthcare delivery system, that means an umbrella which “covers” the uninsured as well as those who are underinsured. The total cost for these points of acute care notwithstanding, how is the best way to explain new numbers out of the CDC this week?

The CDC’s National Center for Health Statistics reported the numbers in its annual summary of U.S. data on disease conditions, health behaviors and use of medical services. The scan figures are based on visits to roughly 500 hospitals and 3,000 doctor’s offices and outpatient clinics.

According to this survey data, the CDC says that the use of imaging modalities in the ED has quadrupled since the mid-1990s. Besides being just another point of confirmation of the origin of skyrocketing healthcare costs in this country, the heavy emphasis placed on tech will not abate anytime soon. Issues pertaining to defensive medicine, integration of such tech into ingrained training of new physicians, and the cost of using such technology within the medical device market are all good reasons to try to begin attacking this startling — yet, unsurprising — statistic. | LINK

Related posts:

1. Study Evaluation Group Offers Results on the Nature of Medical Studies with Positive Results The Cochrane Collaboration, an international body which evaluates published medical...
2. Study: Preponderance of Medical Imaging Due to Overutilization The massive increase in procedures over the past 20 years...
3. Congress Joins AMA in Fight on Medicare Cuts to Imaging Procedures The issue may not be as salient or controversial as...

President Obama appears to have pulled a one-two punch on his selection for the CDC chiefdom, Dr. Thomas Frieden. The LAT has a piece on him, and Obama’s choice turns out to be a rather prudent one. Of course, he wouldn’t have it any other way. Frieden’s marriage of public health activism and renown in the area of public health preparedness makes his choice a perfect one.

Where else would Obama’s need for stern healthcare reform and public policy acceptance by the average healthcare consumer for his ideas be adequately met? In a leader whose background reads like an Obama clarion call to action for a back-to-basics mechanism for healthcare cost cutting (read: heavy emphasis on preventive medicine and wellness, and sound public health principles) — that’s where. Frieden’s experience also personifies the political bridge Obama has sought between the ideological chasm between parties. In a completely soft healthcare economic environment which forces Democrats and Republicans to work together toward solutions, a frontline manager who does Obama’s talking points on this issue is not only necessary, but it’s also an asset. (Additionally, it doesn’t hurt that Frieden is extremely literate in his field of public health policy, having authored over 200 white papers and articles.)

Yep, score one important notch on the long road to public acknowledgement of Obama’s seriousness with respect to the issue of healthcare reform — whether you agree with him or not. | LINK

Related posts:

1. Obama’s Choice for HHS Sec’y Shares Like-Minded Healthcare Policy Visions Call President-elect Obama what you want, but don’t call him...
2. Thursday Newswire: Obama’s New Choice for HHS Sec’y & More Obama appears to be nearing choice for HHS Secretary. Gov....
3. Friday Newswire: Obama Names New CDC Chief & More NY principal with swine flu very ill. Obama names new...

• NY principal with swine flu very ill.
• Obama names new CDC chief.

In a statement, Obama called [Thomas] Frieden “an expert in preparedness and response to health emergencies” who in seven years as New York City’s health commissioner has “been at the forefront of the fight against heart disease, cancer and obesity, infectious diseases such as tuberculosis and AIDS, and in the establishment of electronic health records.”

• CA: A Kaiser hospital is fined a cool quarter mil for a breach of patient confidentiality in “octomom” case.
• Researchers: Common heart abnormality shows increased risk of dementia.
• Pharma company offers free prescription meds for the unemployed.
  

Related posts:

1. Obama Administration Names New CDC Chief President Obama has picked a new CDC head. The candidate...
2. Friday Newswire: A Cure for the Common Cold? & More Doctor who implanted the now famous OctoMom has another patient...
3. Thursday Newswire: Obama’s New Choice for HHS Sec’y & More Obama appears to be nearing choice for HHS Secretary. Gov....