HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

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Saturday, September 8, 2007

Blue Cross of California Meet Consumers

Blue Cross of California has decided to spend millions on dollars to lobby against health reform in California.  In response, a group called "It's OUR Healthcare" has set up a website, which contains personal stories, a blog and some utube videos.  The group states,

The state legislature is down to its final days of the session and Blue Cross alerted their list of insurance agent supporters that current reforms on the table are "unhealthy." (And the status quo isn't?)

If you're sick of groups like Blue Cross standing in the way of healthcare reform, then you'll love our new animated video released today at www.SickOfBlueCross.com/BrightSide. We're asking Californians to watch the video and sign our petition and tell Blue Cross: "Don't stand in the way of reform!"

Very creative!  In care you were not aware of what types of health care reform that are under consideration in California, if you visit the It's OUR Healthcare website, the right side of the page has a listing of recent articles detailing the California legislature's attempt at health care reform. 

September 8, 2007 | Permalink | Comments (0) | TrackBack (0)

New Orleans Nursing Home Owners Aquitted

TalkLeft has a brief story on the acquittal of the Manganos, the New Orleans nursing home owners who had been charged with negligent homicide in the deaths of patients at their nursing home.  The Washington Post provides some further background:

On Friday night, after four hours of deliberations, a jury acquitted the Manganos of negligent homicide, charges that could have put them in prison for life. The case raised broader questions about who, if anyone, deserves to be punished for the deaths in Katrina's deadly flooding.

Though numerous government agencies have been faulted for the disaster, the Manganos were the first and only people to be tried in a criminal court for any of the countless mistakes of planning that led to 1,800 deaths in the flooding that followed the storm late in the summer of 2005. . . . .

"I went back and forth for sure, but when it came down to it, the Manganos were not criminals," the juror, Kim Maxwell, 46, a secretary at a power plant, said later. "I just wanted to hug them." . . .

By all accounts, the Manganos' nursing home offered good care to its residents before the storm.

Mabel, the administrator, sometimes helped bathe and dress the residents; Sal, in charge of maintenance, stopped to spoon-feed those who could not feed themselves. Their son and daughter-in-law helped out.

Having been through Hurricane Betsy in 1965, the Manganos also believed that their nursing home had been built on a high spot and was less vulnerable to flooding.

The Manganos' fears for residents' safety during an evacuation were well-founded, too, according to expert witnesses who testified that nursing homes often suffer fatalities when evacuated.

The trial has been fraught with tears and bitterness, and the relatives of the dead and the Manganos have relived the tragedy.

"They killed 35 people," Joy Lewis, whose mother died in the flooding, said after closing arguments. She added that while she does not necessarily think the Manganos should go to jail, "they should pay" and the specific form would be up to God. "When they put their heads on their pillow at night," she said, "they'll pay."

NPR has additional coverage of the trial here and here.

September 8, 2007 | Permalink | Comments (0) | TrackBack (0)

Friday, September 7, 2007

Combatting Urban Health Myths

The Washington Post reported on the Centers for Disease Control and Prevention completed some interesting research on myths surrounding the flu vaccine and how pervasive they are.  The Post states,

The federal Centers for Disease Control and Prevention recently issued a flier to combat myths about the flu vaccine. It recited various commonly held views and labeled them either "true" or "false." Among those identified as false were statements such as "The side effects are worse than the flu" and "Only older people need flu vaccine."

When University of Michigan social psychologist Norbert Schwarz had volunteers read the CDC flier, however, he found that within 30 minutes, older people misremembered 28 percent of the false statements as true. Three days later, they remembered 40 percent of the myths as factual.

Younger people did better at first, but three days later they made as many errors as older people did after 30 minutes. Most troubling was that people of all ages now felt that the source of their false beliefs was the respected CDC.

The psychological insights yielded by the research, which has been confirmed in a number of peer-reviewed laboratory experiments, have broad implications for public policy. The conventional response to myths and urban legends is to counter bad information with accurate information. But the new psychological studies show that denials and clarifications, for all their intuitive appeal, can paradoxically contribute to the resiliency of popular myths. . . .

Research on the difficulty of debunking myths has not been specifically tested on beliefs about Sept. 11 conspiracies or the Iraq war. But because the experiments illuminate basic properties of the human mind, psychologists such as Schwarz say the same phenomenon is probably implicated in the spread and persistence of a variety of political and social myths.

The research does not absolve those who are responsible for promoting myths in the first place. What the psychological studies highlight, however, is the potential paradox in trying to fight bad information with good information.

Schwarz's study was published this year in the journal Advances in Experimental Social Psychology, but the roots of the research go back decades. As early as 1945, psychologists Floyd Allport and Milton Lepkin found that the more often people heard false wartime rumors, the more likely they were to believe them.  The research is painting a broad new understanding of how the mind works. Contrary to the conventional notion that people absorb information in a deliberate manner, the studies show that the brain uses subconscious "rules of thumb" that can bias it into thinking that false information is true. Clever manipulators can take advantage of this tendency.

The experiments also highlight the difference between asking people whether they still believe a falsehood immediately after giving them the correct information, and asking them a few days later. Long-term memories matter most in public health campaigns or political ones, and they are the most susceptible to the bias of thinking that well-recalled false information is true.

The experiments do not show that denials are completely useless; if that were true, everyone would believe the myths. But the mind's bias does affect many people, especially those who want to believe the myth for their own reasons, or those who are only peripherally interested and are less likely to invest the time and effort needed to firmly grasp the facts.

The research also highlights the disturbing reality that once an idea has been implanted in people's minds, it can be difficult to dislodge. Denials inherently require repeating the bad information, which may be one reason they can paradoxically reinforce it.
Indeed, repetition seems to be a key culprit. Things that are repeated often become more accessible in memory, and one of the brain's subconscious rules of thumb is that easily recalled things are true.

Many easily remembered things, in fact, such as one's birthday or a pet's name, are indeed true. But someone trying to manipulate public opinion can take advantage of this aspect of brain functioning. In politics and elsewhere, this means that whoever makes the first assertion about something has a large advantage over everyone who denies it later. . . .

September 7, 2007 | Permalink | Comments (0) | TrackBack (0)

Hospital Errors

Shannon Brownlee writing at the Washington Monthly discusses the recent studies published in the Seprember 5th edition of Journal of the American Medical Association (JAMA) on reducing hospital errors.  She writes,

HOSPITAL ERROR....Two large studies, published today in the Journal of the American Medical Association, found that cutting the grueling work hours of doctors-in-training had little effect on reducing hospital errors and patient deaths. Surprised? So were the researchers who did the studies.

There are three possible explanations. One, most errors aren't caused by groggy, sleep-deprived, over-worked residents, so giving them more time off won't make any difference in the error rate. Two, the new regulations, which cut residents' typical workweek from 100 hours to 80, didn't reduce their hours enough to make a difference. I mean c'mon, 80 hours a week still doesn't leave much time for eating and sleeping and all those romantic couplings we see on television shows like "ER" and "Gray's Anatomy." Or, three, the number of mistakes made in hospitals is so large, any drop in the errors committed by residents was too small to be measured.

My vote goes to . . . well, let me just offer a couple of statistics. In its seminal 1999 report on the subject, To Err is Human, the Institute of Medicine estimated that as many as 98,000 American patients are killed each year by medical error. Hospitals are such complicated places, the ways that care givers can screw up are almost too numerous to count. A doctor can accidentally perforate a patient's colon during a colonoscopy, leading to infection. Surgeons leave devices or sponges inside wounds and stitch patients up. One intensive care unit that tracked near misses reported 1.7 errors per day per patient, about 30 percent of which could have been serious or fatal. . . . .

The two studies published today suggest why that might be the case. The studies included 318,000 veterans who were cared for at Veterans Administration Hospitals and another 8.5 million Medicare recipients. It turns out, error rates did go down at VA hospitals, but not at the other hospitals in the study.

When it comes to reducing medical error, the VA health system has three things going for it that most other hospitals don't have. Numero uno, every VA hospital has a fully-functioning electronic medical records system.

This system not only helps physicians and nurses avoid many kinds of errors, like giving a patient the wrong drug, it also allows each hospital to track the treatment of every patient. Hospital safety officers can easily give physicians and nurses feedback on how they're doing when they implement any sort of error-reduction program. Other hospitals are left flailing along, hoping that they are making a dent when they initiate some new plan. VA doctors know -- and in real time.

And finally, VA hospitals do a better job of coordinating all the different people who have a hand in a patient's care. Veterans don't tend to fall through the cracks during hand-offs between one shift and the next, for instance. That's why my colleague Phil Longman's book about the Veterans Health Administration is titled Best Care Anywhere. It's also why a Democratic presidential candidate will probably be pointing to the VA in a speech later this month as one model for improving American health care.

September 7, 2007 | Permalink | Comments (0) | TrackBack (0)

Tuesday, September 4, 2007

MS Vaccine Passes Safety Hurdle

Science News Online reports on great news about the future development of a multiple sclerosis vaccine,

An experimental vaccine for people who have multiple sclerosis has proved safe, clearing a necessary first hurdle toward regulatory approval. The results of this initial trial also suggest that the vaccine can indeed quell the self-destructive immune reaction that many scientists believe causes the disease.

Despite this early promise, the researchers caution that the findings are based on data gathered from a small group over a limited time. The researchers used a technique called DNA vaccination, which introduces a gene into the body to elicit an immune response. But rather than rile the immune system against a foreign foe, the new multiple sclerosis (MS) vaccine seeks to induce immune tolerance of myelin basic protein, a component of myelin. A fatty material that protects nerves, myelin is degraded in MS, robbing patients of muscle control.

For the vaccine, researchers at Stanford University and Bayhill Therapeutics in Palo Alto, Calif., designed a DNA ring that encodes a slightly altered version of myelin basic protein. The changes replaced immune-stimulating parts of the protein with immune-suppressing ones.  Scientists gave 30 MS patients four injections over 9 weeks and then tracked their progress for a year. The study was made public this week and will appear in the October Archives of Neurology.  Periodic magnetic resonance imaging of the patients' brains showed that inflammation associated with the nerve damage of MS didn't worsen as a result of the vaccine. . . . .

"This is an important development in the field of MS therapy," says immunologist Gérald J. Prud'homme of the University of Toronto, who wasn't part of the study team. "This is the first demonstration of a beneficial effect of DNA vaccination in a clinical trial of autoimmune disease." The vaccine may inhibit myelin damage in several ways, Bar-Or says. For example, the vaccine's DNA apparently enters the nuclei of dendritic cells and other traffic cops that orchestrate immune reactions, he says. Because of the DNA's tweaked structure, the myelin basic protein that these cells then produce isn't seen as an enemy, and other immune cells decrease their responses against it. . . .

Meanwhile, the findings have cleared the way for a larger trial designed to assess whether the therapeutic vaccine can limit the nerve damage that marks MS. In that study, researchers have already given 290 patients a longer course of the vaccine than the safety study entailed. The team expects to release the results of the current study within the next year.

September 4, 2007 | Permalink | Comments (0) | TrackBack (0)

Human Genome Project Produces Results

McClatchy News reports on the latest and very exciting, developments resulting from the Human Genome Project

Four years ago, scientists triumphantly announced that they’d finished reading the entire human genome — the 3 billion "letters" of DNA that are the instruction manual for making a person.  Trouble was, they didn’t know how to make sense of the bewildering clutter of A's, C’s, G’s and T’s in the so-called "book of life." Now the genome project is beginning to bear fruit. A bumper crop of fresh discoveries connects specific bits of DNA to numerous diseases, including cancer, diabetes, blindness and AIDS.

New findings are being published almost weekly in scientific journals. Scientists say they're important steps toward future treatments or cures. "A whole series of studies is coming down the pike," Teri Manolio, a geneticist at the National Human Genome Research Institute in Bethesda, Md., told a genome conference in Boston this summer. "This is an unprecedented opportunity to apply genetics to disease."

The latest discovery is a report published in the journal Nature on Sunday declaring that two tiny changes in human DNA may add more than an inch to an individual’s height. An Aug. 2 paper in The New England Journal of Medicine identified other DNA variants that may predispose a person to a heart attack. Armed with such knowledge, doctors can recommend changes in lifestyle, such as losing weight and stopping smoking, that could save a patient’s life. . . .

The detection of a DNA variant related to a disease doesn’t mean that a cure is just around the corner. Some variants raise the risk of disease only slightly, and multiple genes are usually involved in complex diseases. The variant itself may not be to blame, but it shows the location along a strand of DNA where the trouble lies, helping researchers find the culprit. . . .

September 4, 2007 | Permalink | Comments (0) | TrackBack (0)