HealthLawProf Blog

Naughty or Nice Over the Past Year?

Just in time for the New Year . . . take the Test.

Pharmacueticals in the Fight Against Terrorism

The Washington Post reports on latest technology used in the fight against terrorism - it is viagra (ok, this gets a major ick from me but then again I am not an expert in terrorism).  The Post story states,

The Afghan chieftain looked older than his 60-odd years, and his bearded face bore the creases of a man burdened with duties as tribal patriarch and husband to four younger women. His visitor, a CIA officer, saw an opportunity, and reached into his bag for a small gift. Four blue pills. Viagra.  "Take one of these. You'll love it," the officer said. Compliments of Uncle Sam.

The enticement worked. The officer, who described the encounter, returned four days later to an enthusiastic reception. The grinning chief offered up a bonanza of information about Taliban movements and supply routes -- followed by a request for more pills.

For U.S. intelligence officials, this is how some crucial battles in Afghanistan are fought and won. While the CIA has a long history of buying information with cash, the growing Taliban insurgency has prompted the use of novel incentives and creative bargaining to gain support in some of the country's roughest neighborhoods, according to officials directly involved in such operations.

In their efforts to win over notoriously fickle warlords and chieftains, the officials say, the agency's operatives have used a variety of personal services. These include pocketknives and tools, medicine or surgeries for ailing family members, toys and school equipment, tooth extractions, travel visas, and, occasionally, pharmaceutical enhancements for aging patriarchs with slumping libidos, the officials said.

"Whatever it takes to make friends and influence people -- whether it's building a school or handing out Viagra," said one longtime agency operative and veteran of several Afghanistan tours. Like other field officers interviewed for this article, he spoke on the condition of anonymity when describing tactics and operations that are largely classified. . . .

Cigna Sued for Coverage Denial

Associated Press reports on a lawsuit against Cigna for failing to pay quickly enough for a liver transplant for a young teen.  The story states,

The lawsuit filed last week in Los Angeles County Superior Court by the family's attorney, Mark Geragos, alleges breach of contract, unfair business practices and intentional infliction of emotional distress. The suit accuses Cigna of delaying and rejecting valid claims, which resulted in the wrongful death of Nataline Sarkisyan.

The Philadelphia-based insurer eventually approved the transplant after Sarkisyan's family held a rally outside Cigna's suburban Los Angeles office. Nataline, however, died hours after the approval was secured. Chris Curran, a spokesman for Cigna, said the company empathizes with the family but feels the lawsuit is without merit. Curran said Cigna volunteered to pay for the procedure out of its own pocket and not the employer's. . . .

Nataline was diagnosed with leukemia at 14 and received a bone marrow transplant from her brother the day before Thanksgiving 2007. A complication, however, caused the teen's liver to fail. The family had asked Cigna to pay for a liver transplant but the insurer refused, calling the procedure experimental.  In a subsequent letter to Cigna, four doctors from Mattel Children's Hospital at UCLA Medical Center appealed to the insurer to reconsider. They said patients in similar situations who undergo transplants have a six-month survival rate of about 65 percent.

The insurer eventually reversed the decision while about 150 nurses and community members rallied outside its office in Glendale. By this time, however, the teen had fallen into a vegetative state and was taken off life support. She died within the hour.

Just for Fun - and a Laugh

Click here.

Thanks to Firedoglake for the link.

Happy Holidays

Hope everyone has a very Happy Holiday Season!

Hospital Harms: A Top 10 List

The Wall Street Journal Health Blog has a handy list of potential harms that could occur should you find yourself visiting a hospital in the near future.   

The ECRI Institute, which researches patient safety issues, issued its second annual report on the top 10 technology hazards that every hospital should pay more attention to.

Without further ado, here are the top five problems for 2008:

1.      Alarm hazards

2.      Needlesticks and injuries from sharps

3.      Air embolisms from contrast media injectors

4.      Retained devices and fragments left in patients

5.      Surgical fires

Five hazards, including air embolisms from contrast injectors, make their debut this year, shouldering aside some doozies, like infusion pump programming errors and the misconnection of blood pressure monitors to IV lines. . . .

Alt [the report's author] says the report is intended to highlight all the things that can go wrong, so users can understand “where things can fall apart” and take steps to avoid problems. And while some problems involve a faulty device alone, he says, there’s usually some contribution from the operator. “No one reads the manual, or even has the manual after day one,” he says. Even if they are trained properly, he adds, “they get busy or move on to something else.”

I am thinking that this list will never make it to David Letterman -- it really isn't funny at all.  If more people new about these event, however, perhaps there wouldn't need to be such a list.

Cute and Sleepy

Here is a website for all of those who might have some problems sleeping tonight (or to those looking for something sweet and perhaps overly cute on this Christmas Eve).

FDA Reforms

The Diane Rehm show had an interesting and informative hour yesterday on the Food and Drug Administration and suggestions for reform.  The program overview provides, 

Food scares and drug scandals have raised serious concerns over the F.D.A.’s ability to regulate effectively. A look at the resources and direction at the Food and Drug Administration, and why some are hoping for significant changes under the next administration.

Guests

Gardiner Harris, a science reporter for "The New York Times"

Alan Goldhammer, PhD, associate vice president for regulatory affairs at the Pharmaceutical Research and Manufacturers of America (PhRMA)

Dr. Sidney Wolfe, director of the Health Research Group at Public Citizen; editor of WorstPills.org

Rep. Rosa de Lauro, U.S. Congresswoman, representing Connecticut's 3rd district; chairwoman of the Agriculture-FDA Appropriations Subcommittee

William Hubbard, former associate commissioner for the Food and Drug Administration; spokesperson for the Alliance for a Stronger FDA

Ezekiel Emanuel: New Health Policy Advisor

Maggie Mahar at Health Beat notes the appointment of Ezekiel Emanuel, a bioethicist at the National Institutes of Health and Rahm Emanuel's brother, as the senior counselor at the White House Office of Management and Budget for Health Policy.  She writes of Mr. Emanuel and the position,

“Zeke Emanuel will work closely with Department of Health and Human Services secretary-nominee Tom Daschle to formulate a national health insurance program and to try to curb the swelling cost of health insurance without adversely impacting health care. . .

As regular readers may remember, I’ve written about the plan for universal coverage that Zeke Emanuel outlines in his book Healthcare,Guaranteed in two posts: The first post begins:

“Imagine a proposal for health care reform that guarantees free, high quality health care for all Americans. "No premiums. No deductibles. Under this plan, the government insists that all insurers offer the same comprehensive benefits to everyone including: office and home visits, hospitalization, preventive screening tests, prescription drugs, some dental care, inpatient and outpatient mental health care and physical and occupational therapy. . . .

“If this all sounds too good to be true, you need to read Health Care, Guaranteed by Dr. Ezekiel Emanuel..." Part 1 of the post is here and Part 2, here.

The plan, originally developed by Emanuel and health care economist Victor Fuchs, remains the best proposal for healthcare reform that I have seen. Granted, it lacks a public sector “Medicare for All” option which observers like Jacob Hacker believe is important. (See the paper that Hacker just released here)  But Emanuel has told me that he sees no reason a public sector insurance option couldn’t’ be included. He just doesn’t think it is necessary if private sector insurers are regulated as described in his book. . . .

Health CEO Helps Bring Down Blago

 The New Yorker   has a short piece on Pamela Davis, the CEO of Edward Hospital, who helped the FBI gather evidence against Illinois Governor Rod Blagojevitch.  Nina Burleigh writes,

Pamela Davis, blond suburban mother of three, was told that her bra would be the best place to wear the wire that kick-started a long investigation into Chicago graft and that ultimately caught the governor of Illinois trying to sell Barack Obama’s Senate seat. Davis is the president and C.E.O. of Edward Hospital, in Naperville, Illinois. She is proud of the fact that on her twenty-year watch the hospital has grown from a hundred-and-sixty-two-bed community facility to a four-hundred-and-twenty-seven-bed regional medical center that leads the county in babies delivered.

Back in 2003, Davis was trying to get approval for a new medical office building from the Illinois Health Facilities Planning Board. A night or two before a hearing was to be held, Davis recalled, something strange happened. A business acquaintance of hers, Nicholas Hurtgen, then a managing director of the Chicago office of Bear Stearns, called her at home and told her that unless she agreed to use a certain contractor she should pull her building request, because it wasn’t going to be approved.

She ignored the warning and went off to the board hearing, where she was surprised to find that her request was denied. “I was humiliated,” she said. “They were mean. So I walk off, and then a different guy comes up to me and he says, ‘We told you to pull your project. Call me.’ And right then I decided to call the F.B.I.”  At first, the agents she contacted thought she was a crank. “I could tell they were laughing at me. Most people who call the F.B.I. are crazies. So they sort of humored me and said, ‘O.K., we will come out and listen once.’ ”

A few days later, three F.B.I. agents met her at her office, bugged her phone, and outfitted her with the wire to put in her bra. Then they set up camp in a van in the parking garage and waited. “They said, ‘You tell nobody anything, not even your husband.’ They were laughing at me and I was laughing at them.”  The agents had instructed Davis to invite Hurtgen and Jacob Kiferbaum, the contractor whom he had mentioned over the phone, to meet at her office. When they arrived, the F.B.I. men listened in on the conversation from the van.

As Davis recalled, “They say, ‘We told you to pull the project.’ And I say, ‘Yeah, why do I need you?’ And they start saying, ‘If you don’t hire us, you will never get this project approved.’ After about five minutes, my phone rings, and now the three F.B.I. guys in the parking garage are saying, ‘It’s extortion! It’s extortion!’ They yell, ‘Get ’em out! Get ’em out!’ So I hang up the phone. . . .

That episode helped start United States Attorney Patrick Fitzgerald’s Operation Board Games. For the next seven months, Pamela Davis, hospital administrator, became Pamela Davis, secret agent, helping to expose a multimillion-dollar scam that at times resembled a spinoff of “The Sopranos,” guest-starring the back office from “Grey’s Anatomy.” Davis attended long lunches and boozy dinners with crooked businessmen, listening (and taping) as they talked of grafting off the hospital industry. She would slip the tapes to her F.B.I. handlers at Marshall Field’s makeup counters in malls around suburban Chicago. . . .

Davis got a court order allowing her to hire a lawyer and to tell her hospital-board chairman what she was up to. After seven months, the Chicago Sun-Times published her name in a blind item about an ongoing corruption investigation, and Davis’s role in the case was over. Her tapes of Stuart Levine, a corrupt health-board member, helped lead to his becoming a federal witness in the trial of Antoin (Tony) Rezko. (Kiferbaum pleaded guilty to attempted extortion in 2005. Hurtgen maintains his innocence, and his lawyer disputed Davis’s account.)

As Fitzgerald’s probe widened, more wiretaps were put in place, and more corruption was exposed. Eventually, the governor of Illinois was recorded discussing the sale of Obama’s Senate seat. Davis, who describes herself as a political independent, says she’s disgusted with politics now, although she did vote for Obama. And she still hasn’t received state approval for her hospital expansion. ♦

Beware: Wii Injuries

The holiday season spoiling folks at the British Telegraph bring us the news that doctors are concerned about injuries from excessive Wii play.  The newspaper reports,

The games, which encourage players to mimic the actions of sports, can cause   painful sprains and fractures, they added. Although the games have been praised for encouraging people to be more active,   using them incorrectly or for long periods can lead to injuries.

This year, the Wii is predicted to be one of the most popular Christmas   presents. But doctors said those who spent too long on the games, especially   those unused to exercise, were at risk of strain. Researchers at Leeds Teaching Hospital have identified an injury they called "Wii   knee". Last year, osteopaths reported that they saw an increase in back   patients after Christmas, and blamed the trend on fathers trying to keep up   with their children on the machines.

The British Society for Surgery of the Hand (BSSH) also said there had been an   increase in the number of injuries caused by excessive use of Wii.  Richard Milner, of the BSSH and a consultant plastic and hand surgeon, said   that he expected the number of patients to increase over Christmas. He said: "We   treated a patient this week who had injured herself using a Wii. She was   playing tennis with a partner and fractured one of the bones in her finger   when he hit the back of her hand with the control.". . .

Perhaps some more warnings are in order . . . .

Wearing a Hat . . . .Medical Myth?

Since most of the country is experiencing some rather nasty cold weather, here is a report from the British Medical Journal to let you know that all those calls for you to wear a hat might have been less than helpful.  Here is a brief excerpt from the Guardian. Ian Sample writes,

When it comes to wrapping up on a cold winter's day, a cosy hat is obligatory. After all, most of our body heat is lost through our heads – or so we are led to believe.  Closer inspection of heat loss in the hatless, however, reveals the claim to be nonsense, say scientists who have dispelled this and five other modern myths.

They traced the origins of the hat-wearing advice back to a US army survival manual from 1970 which strongly recommended covering the head when it is cold, since "40 to 45 percent of body heat" is lost from the head.

Rachel Vreeman and Aaron Carroll, at the centre for health policy at Indiana University in Indianapolis, rubbish the claim in the British Medical Journal this week. If this were true, they say, humans would be just as cold if they went without a hat as if they went without trousers. "Patently, this is just not the case," they write.

The myth is thought to have arisen through a flawed interpretation of a vaguely scientific experiment by the US military in the 1950s. In those studies, volunteers were dressed in Arctic survival suits and exposed to bitterly cold conditions. Because it was the only part of their bodies left uncovered, most of their heat was lost through their heads.

The face, head and chest are more sensitive to changes in temperature than the rest of the body, making it feel as if covering them up does more to prevent heat loss. In fact, covering one part of the body has as much effect as covering any other. If the experiment had been performed with people wearing only swimming trunks, they would have lost no more than 10% of their body heat through their heads, the scientists add. . . .

The report also debunks other seasonal myths about children, sugar and hyperactivity (not sharing this article with my "just one more cookie Mom" son) and some rather bad news for those interested in hangover remedies as well.  The article is an interesting read.