We Don't Take Medically Needy People...,

wave3  |  This story began December 1 at 5 p.m. with a phone call to our newsroom from a horrified University Hospital employee. The employee claimed security had just wheeled an elderly woman all the way out to the corner of Hancock and Ali, just off hospital property, dumped the woman out of the wheelchair on the sidewalk and left.

Minutes later, we shot video of her still in a soiled hospital gown and slippers, breathing hard under a blanket placed over her in 36 degree weather. Her stuff was in a bag next to her.

The caller claimed she saw this a lot.

So I started watching, and on December 16 at 7 p.m., 35 degrees outside, I recorded three security guards surrounding an elderly woman with a walker and slowly escorting her out of the emergency room.

She couldn’t move fast.

It took several minutes to make it all the way to the same corner of Hancock and Ali.

After they had her across the street off the hospital property, the security guards turned around and went back.

When they cleared I caught up to her. She said she couldn’t breathe.

“They told me I would not stay on the premises,” she said.

“Were you there as a patient?” I asked.

“I needed to be a patient because I’m sick,” she said.

“What’s wrong with you?” I asked.

“I’ve got COPD,” she said. “I got diabetes.”

“So they wouldn’t treat you?” I asked.

“The doctor talked to me for one minute,” she said.

“And told you what?” I said.

“That I had to leave,” she said.

“What reason did he give you?” I asked.

“He didn’t give me a reason,” she said.

She told me she was homeless.

“I’ve got to go because I’m hurting,” she said. “I’m in pain.”

Matthew Hauber and his mother claimed a similar story. They met us in front of Wayside Christian Mission in the spot where they said he was dumped in October.

“I was in a car crash,” Matthew said. “I completely shattered my hip and pelvis. I got like 30-some screws.”

“They said we can’t find a rehab right now,” Linda Hauber said.

She said when Norton Hospital told her they had a room lined up for Matthew at Wayside, she checked it out.

“I called Wayside just to confirm, and they said ‘No, we can’t do that, we can’t.’” Linda said. “‘We have beds and help find jobs, but we don’t take medically needy people, we don’t do that.’”

She said she then had a conference call with the hospital staff.

“The social worker said ‘We’re going to take him to a shelter’ and I said ‘Which one?’” Linda said. “And they said Wayside Christian Mission. And I said ‘Well I know that’s not true, because I called them and they don’t take them.’ Then the social worker said ‘That’s history, we’ll think of something else.’”
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Linda said the next day, her son was unloaded from a transport vehicle on the curb in the rain on Jackson Street in front of Wayside.

“I thought ‘They’ve dumped my son...’ my garbage I have to put out to the curb, that’s how they dumped my son,” Linda said. “Like garbage.”

Linda said she was in no shape to care for him at home. She died after the interview with us.

“They put all their stuff on the sidewalk over there, dump them off on the sidewalk, get back in their vehicle and get out of here just as fast as they can,” Wayside staffer Perry Layne said.
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When The Hospital Wants You Gone: Unsolved Problems Are Simply Eliminated

knoxnews |  The Knoxville Police Department on Feb. 23 released video recordings of the arrest of a 60-year old woman who collapsed while she was being taken to jail and later died, and said the investigation into how officers handled the incident will continue.

Community reaction to the videos was swift: Nearly 400 comments, the majority critical of how officers handled the situation, appeared within hours on the department's Facebook post of a compilation showing excerpts from various police cameras.

Lisa Edwards, 60, was arrested Feb. 5 outside Fort Sanders Regional Medical Center, where she had been treated earlier. Hospital security called police when Edwards declined to move off the property after she was discharged.

Here's what Knox News knows about Edwards' arrest, her death and the ongoing police investigation.

'This shouldn’t happen': Family of woman who collapsed in KPD custody plans to sue

What did the body camera footage show?

A police video compilation from the Feb. 5 arrest shows how officers arrested her and what happened after she lost consciousness in the car. The compilation includes excerpts from body-camera footage of the initial interaction with Edwards, body camera footage of officers taking her into custody, and in-car camera footage from the time she was placed into the back of a cruiser.

Sgt. Brandon Wardlaw, officer Adam Barnett, officer Timothy Distasio and transportation officer Danny Dugan are shown in the video compilation. All four are on paid leave during the internal affairs investigation.

Body cam footage shows the first KPD officer arrived just before 8 a.m., about an hour after Edwards was discharged from the hospital. Edwards told the officer she had a stroke and couldn’t walk, but he responds by telling her the hospital wants her gone.

 

 

What "A Midwestern Doctor" Had To Say About Carlson's Broadside On The Medical Industrial Complex

Tucker Carlson takes a look at the effects the COVID vaccine is being shown to have on people. pic.twitter.com/G7WlV8BKLe

— The Post Millennial (@TPostMillennial) July 26, 2022

I was in the doctors lounge this evening with two other docs.

Tucker came on. A 20 minute monologue about Big Pharma and the corruption Thereof. I simply could not believe what I was seeing.

He took 20 minutes and decimated opiates, SSRIs, COVID vaccines, Fauci, Birx, and the Biogen Alzheimer’s drug.

If you want an idea what I am barraged with daily even by the MSNBC crowd, look no further. I hear these same issues from patients all day long.

Tucker clearly has his problems but he also clearly has balls of steel. The execs at Fox with Big Pharma providing about half their revenue must clearly know the gig is up or they would not be allowing this on TV.

People are getting more enraged by the day. It is clips like this that make me certain the day of reckoning is coming soon.

Both the other docs in the lounge tonight, MSNBC watchers, agreed with me that there is not a thing in this monologue to be quibbled about.

Since the mid 2000s, right when Tom Cruise did his SSRI interview with Lauer – Tucker played part of it – the original Lilly Pfizer papers have been a standard the world over on how data is manipulated and how relative risk is abused. I have used them as examples of inappropriate data manipulation in classes for more than a decade. Most physicians with a questioning mind have known these drugs were a problem for years. And this is the first time I have ever heard this discussed on national TV in my life.

The Birx clip he features “I knew they were not going to be effective stopping the spread of the virus” was played today in a conference. Immediately followed by the Fauci, Walensky, Biden, and Maddow clips detailing that the vaxxes were a dead end, that you would never catch it, etc.

The ID fellow presenter, whose hospital and clinics are now being overrun with vaxxed and boosted COVID patients, after the above clips were played, in a dull monotone said, “One needs to ask WHAT exactly did these people know and more importantly WHEN did they know it?”

I could scarcely believe it. That kind of talk would have garnered intense guffaws and probably a trip to the chairman’s office just a few weeks ago. Now silent resignation.

The Fauci clip where he is asked about menstrual problems and states “we are going to study it….”. An epidemiologist commented “Seriously, you forced this upon millions of young women, and ONLY now we are going to study it? Did anyone have a hint this was a problem before the mandates? Knowing Pfizer’s history, my gut tells me they knew all too well.”

And yet another zinger from a retired ID professor – “If they knowingly released a non-sterilizing vaccine into an acute coronavirus pandemic and forced millions to take it, that may be the greatest act of medical malpractice in the history of this whole world.”

I am slowly seeing the return of “science” in my profession. Tough questions are being asked. Finally.

What do I feel tonight ….. the sun is shining, the scales are falling out of the eyes…and we are on the Road to Damascus. This may take quite a bit longer than you would expect, but I am fairly sure this is going to get really interesting

Believers Don't Know How The Coronavirus Is Getting Them Killed

nymag |  In an acute column published April 13, the New York Times’ Charlie Warzel listed 48 basic questions that remain unanswered about the coronavirus and what must be done to protect ourselves against it, from how deadly it is to how many people caught it and shrugged it off to how long immunity to the disease lasts after infection (if any time at all). “Despite the relentless, heroic work of doctors and scientists around the world,” he wrote, “there’s so much we don’t know.” The 48 questions he listed, he was careful to point out, did not represent a comprehensive list. And those are just the coronavirus’s “known unknowns.”

In the two weeks since, we’ve gotten some clarifying information on at least a handful of Warzel’s queries. In early trials, more patients taking the Trump-hyped hydroxychloroquine died than those who didn’t, and the FDA has now issued a statement warning coronavirus patients and their doctors from using the drug. The World Health Organization got so worried about the much-touted antiviral remdesivir, which received a jolt of publicity (and stock appreciation) a few weeks ago on rumors of positive results, the organization leaked an unpublished, preliminary survey showing no benefit to COVID-19 patients. Globally, studies have consistently found exposure levels to the virus in most populations in the low single digits — meaning dozens of times more people have gotten the coronavirus than have been diagnosed with it, though still just a tiny fraction of the number needed to achieve herd immunity. In particular hot spots, the exposure has been significantly more widespread — one survey in New York City found that 21 percent of residents may have COVID-19 antibodies already, making the city not just the deadliest community in the deadliest country in a world during the deadliest pandemic since AIDS, but also the most infected (and, by corollary, the farthest along to herd immunity). A study in Chelsea, Massachusetts, found an even higher and therefore more encouraging figure: 32 percent of those tested were found to have antibodies, which would mean, at least in that area, the disease was only a fraction as severe as it might’ve seemed at first glance, and that the community as a whole could be as much as halfway along to herd immunity. In most of the rest of the country, the picture of exposure we now have is much more dire, with much more infection almost inevitably to come.

But there is one big question that didn’t even make it onto Warzel’s list that has only gotten more mysterious in the weeks since: How is COVID-19 actually killing us?

Managerialism Hijacked, Parasitized, and Controls the American Medical Narrative

hcrenewal  |  A news article that featured an interview with Dr Victor Montori, the senior author of the article, noted in fact that the most recent (2018) list included quite a few CEOs of large for-profit health care corporations.

Among those topping the latest installment of the influential Modern Healthcare power index are the corporate heads of Amazon, Apple, Aetna, Humana, CVS and Minnetonka, Minn.-based United Health/Optum.

The authors concluded that

perceived influence over US health care of chief executives of health systems is increasing. To the extent that the ranking validly reflects influence, the sharp rise in the influence of chief executive officers at the expense of representatives of patients or health professionals may underscore the increasing industrialization of health care. It is not possible to find patients, patient advocates, clinicians, or clinician advocates at the top of this list. This trend placing health care influencers within C-suites, accountable to boards mostly comprising other corporate leaders, may explain the rise of business language and thinking

They suggested that it is possible that there is a

causal association between the concentration of executive influence and problems of patient care derived from efforts to optimize operational efficiency and financial performance, for example, clinician burnout, the heavy burden of treatment afflicting patients with chronic conditions, and the erection of barriers to care to optimize 'payer mix.'

Dr Montori also said in the interview

Americans increasingly find themselves in a corporate-centric healthcare echo-chamber, one in which the public will increasingly approach tough policy decisions having heard only the viewpoint from the top.

'The primary goals of CEOs are to advance the mission of their organization,' Montori says. 'If all that influences healthcare are the ideas of people who advocate for the success of their organizations, people who are not served by them will not have their voices heard.'

Furthermore, he suggested that the public may be befuddled by the current health policy debates, including those about universal health care and the possibility of reducing the power of commercial health insurance companies because

in the rest of the narrative all that they hear is about are the successes of biotech, the successes of tech companies, and the successes of healthcare corporations who achieve high levels of innovation thanks to the bold leadership of their executives. It's why we have been calling for greater awareness of the industrialization of healthcare for some time now

Unsubstantiated Drug Price Increases

angrybearblog |  The ICER (Institute for Clinical and Economic Review)

Is an independent and non-partisan research organization. Its purpose is to evaluate the clinical and economic value of prescription drugs, medical tests, and health care and health care delivery innovations. ICER conducts rigorous analyses of all clinical data with key stakeholders to include patients, doctors, life science companies, private insurers, and the government and translate the evidence into policy decisions that lead to a more effective, efficient, and just health care system.

As explained by their site information, ICER is known as the nation’s independent watchdog on drug pricing. It’s drug assessment reports include a full analysis of how well each new drug works and the resulting “clinical value, quality of life, benefit to the health-care system and society” used to establish a price. Using the drug assessment report, a “value-based price benchmark” is established  reflecting how each drug should be priced addressing all four factors. Reports also evaluate the potential short-term budget impact of new drugs to alert policymakers to situations when short-term costs may strain health system budgets and lead to restrictions on patient access. Ensuring objectivity in its work, all ICER reports are produced with funding from non-profit foundations and other sources that are free of conflicts of interest from the life science industry or insurers.

What I have seen in the past is the ICER establishing pricing for new drugs taking into consideration these factors; “the patient’s quality of life, and the resulting benefits to the health-care system, and society.” This is the first time I am seeing the ICER looking at price increases and determining whether the value delivered substantiates a price increase. By the numbers: Here are the drugs (and manufacturers) highlighted in a recent ICER’s report, with the increase in net spending attributable to each drug’s price increase, and citing the increases could not be justified by the value delivered.

America's Healthcare Rip-off

nakedcapitalism |  Yves here. Reader Christopher J sent a contribution from Down Under, with a long note about his treatment for his first major medical treatment. I thought I would run it as a long-form example of how health care works in other advanced economies. Admittedly, my personal data points are stale, but when I was in Sydney (2002-2004), the caliber of health care was on a par with the US, and even with my paying out of pocket, the charges were about a third of what they would have been in the US. A couple I knew who had the option of the wife giving childbirth in New York City or Sydney chose Sydney because they deemed the care to be better. 

One of the big things that allows for America’s health care looting to go well beyond what ought to have been its sell by date is our provincialism. 

You can read about the Australian scheme here; the short version is citizens and permanent residents pay 2% of their annual income over a threshold for Medicare; they can then either buy private insurance or pay a surcharge for the balance of their coverage.

Christopher J lives in Cairns, which is a remote city of 150,000 near the Great Barrier Reef. 

By Christopher J

I follow your blog most days and have been a part time commenter for well over 10 years now, since I worked for the Bureau of Transport Economics in Canberra. 

Here is a story about my first medical emergency. I was born in the UK in 1961 and now live in Cairns after working in the public sector for 30 plus years in the finance and treasury sectors. I currently work for self as handyman and have a partner who also works.

Last September 2018, I gave up smoking cigarettes due to the expense. Heavily taxed to ‘discourage use’, a 20 pack of Marlboros now costs around A$30 – $20 US. And, I reckon my habit was costing around $750 a month, or the cost of an annual river cruise in Europe! I’d given up several times for months or even years, but this was the first time I’d given up arising from anger at how the Federal Government was tackling the problem with a huge tax on, mostly, working people.

After that first month, I withdrew the money I’d saved in cash and bought myself a flash wallet to put it in. Smug I was at the pub around my smoking friends. I found huge improvements in my health. For many years sleeping on my side led to my arms going to sleep as my circulation was constricted by all that smoke residue. After a month or so of not smoking, my blood circulation improved and I found I could sleep again on my side. I told partner we were going to extend all our run circuits by about 800 m and we started to hike up Mount Whitfield, and jog down, about an 8km round trip with an up and down of around 350m, with the trail along the ridge line. I was feeling very fit for my age and was feeling generally positive about my health and well being.

At the end of May, or so, and out of the blue, I found a lump as I was sitting on the bed one morning. This was a Monday about 4 months ago. At the top of my right thigh and groiu area was a lump, not painful, about the size of a small egg.’

Hepatitis C is Curable, Just Not For You...,

CNN |  Hepatitis C-related deaths reached an all-time high in 2014, the Centers for Disease Control and Prevention announced Wednesday, surpassing total combined deaths from 60 other infectious diseases including HIV, pneumococcal disease and tuberculosis. The increase occurred despite recent advances in medications that can cure most infections within three months.

"Not everyone is getting tested and diagnosed, people don't get referred to care as fully as they should, and then they are not being placed on treatment," said Dr. John Ward, director of CDC's division of viral hepatitis. 

At the same time, surveillance data analyzed by the CDC shows an alarming uptick in new cases of hepatitis C, mainly among those with a history of using injectable drugs. From 2010 to 2014, new cases of hepatitis C infection more than doubled. Because hepatitis C has few noticeable symptoms, said Ward, the 2,194 cases reported in 2014 are likely only the tip of the iceberg.

"Due to limited screening and underreporting, we estimate the number of new infections is closer to 30,000 per year," Ward said. "So both deaths and new infections are on the rise." 

"These statistics represent the two battles that we are fighting. We must act now to diagnose and treat hidden infections before they become deadly, and to prevent new infections."

partial ectogenesis exists..., let the pearl-clutching and vapor-catching begin

geneticliteracyproject |  Scientifically, it’s calledectogenesis, a term coined by J.B.S. Haldane in 1924. A hugely influential science popularizer, Haldane did for his generation what Carl Sagan did later in the century. He got people thinking and talking about the implications of science and technology on our civilization, and did not shy away from inventing new words in order to do so. Describing ectogenesis as pregnancy occurring in an artificial environment, from fertilization to birth, Haldane predicted that by 2074 this would account for more than 70 percent of human births. 

His prediction may yet be on target.

In discussing the idea in his work Daedalus–a reference to the inventor in Greek mythology who, through his inventions, strived to bring humans to the level of the gods–Haldane was diving into issues of his time, namely eugenics and the first widespread debates over contraception and population control.

Whether Haldane’s view will prove correct about the specific timing of when ectogenesis might become popular, or the numbers of children born that way, it’s certain that he was correct that tAt the same time, he was right that the societal implications are sure to be significant as the age of motherless birth approaches. They will not be the same societal implications that were highlighted in Daedalus, however. 

Technology developing in increments

Where are we on the road to ectogenesis right now? To begin, progress has definitely been rapid over the last 20-30 years. In the mid 1990s, Japanese investigators succeeded in maintaining goat fetuses for weeks in a machine containing artificial amniotic fluid. At the same time, the recent decades have seen rapid advancement in neonatal intensive care that is pushing back the minimum gestational age from which human fetuses can be kept alive. Today, it is possible for a preterm fetus to survive when removed from the mother at a gestational age of slightly less than 22 weeks. That’s only a little more than halfway through the pregnancy (normally 40 weeks). And while rescuing an infant delivered at such an early point requires sophisticated, expensive equipment and care, the capability continues to increase.

A comprehensive review published by the New York Academy of Sciencesthree years ago highlights a series of achievements by various research groups using ex vivo (out of the body) uterus environments to support mammalian fetuses early in pregnancy. Essentially, two areas of biotechnology are developing rapidly that potentially can enable ectogenesis in humans, and, along the way, what the authors of the Academy review callpartial ectogenesis.

strict texas law protects medical-industrial egregores from patients and employees...,

observer |  One of the unexpected lessons from the Ebola cases in Dallas may well be how thoroughly Texas protects hospitals—and their insurance companies—from answering for critical lapses in care.

When Thomas Eric Duncan entered the Texas Health Presbyterian Hospital’s emergency room on Sept. 25 with a fever and complaining of stomach pain, there’s a chance that proper treatment might have saved him from the Ebola virus that would kill him 13 days later. Instead, the Liberian man was sent home with only painkillers and antibiotics. Duncan’s family and his fiancée are haunted by the question of whether Duncan might have survived had he been properly diagnosed. Executives at Texas Health Presbyterian Hospital have admitted to mistakes and apologized to Duncan’s family.

But should Duncan’s family members seek more than an apology, and ask the courts to hold the hospital accountable for its missteps, they won’t find much recourse under Texas law. Neither will the nurses who contracted Ebola while treating Duncan, apparently for a time without sufficient safety gear, nor will anyone who might have contracted the virus from them later.

Thanks to a number of Texas court decisions and laws—including a sweeping 2003 Republican-led tort reform effort—lawyers say it’s unlikely that Presbyterian faces serious legal risk from the Ebola cases or others like them. Even if the hospital were found liable in court, the damages would be limited. Without the threat of expensive litigation, critics of tort reform argue, hospitals face little consequence for turning away sick, uninsured patients, even ones with Ebola.

The Dallas Morning News has reported that Duncan’s family members are considering a lawsuit against the hospital. The first challenge they would face is probably the greatest: proving that Duncan ever had a better-than-even chance of survival once he’d contracted the virus. With Ebola’s global mortality rate estimated recently at 70 percent, doctors and hospitals are probably safe from ever answering for even the most blatant malpractice against an Ebola patient. That’s not necessarily true in states where courts have adopted what’s known as a “loss of chance” doctrine allowing lawsuits even when the chance of survival is under 50 percent. But Texas’ courts have consistently shut the door to that possibility, ruling that if a patient was likely to die, then the hospital can’t be held liable for malpractice.

If there were a way past that barrier, Duncan’s family would face the same obstacles any other patient has since Texas’ 2003 tort reform law took effect. The law requires emergency room patients to prove not just negligence on the part of hospital staff but “willful and wanton” negligence. That “emergency room standard” is one of a few changes introduced in the tort reform law that raised the standard for lawsuits against hospitals. Another section of the law, related to hospitals’ responsibility for credentialing dangerous doctors, has protected another Dallas-area hospital from litigation over a dangerous Dallas neurosurgeon who killed two patients and paralyzed four others in a series of botched surgeries.

u.s. hospitals weigh withholding care to ebola patients...,

reuters |  The Ebola crisis is forcing the American healthcare system to consider the previously unthinkable: withholding some medical interventions because they are too dangerous to doctors and nurses and unlikely to help a patient.

U.S. hospitals have over the years come under criticism for undertaking measures that prolong dying rather than improve patients' quality of life.

But the care of the first Ebola patient diagnosed in the United States, who received dialysis and intubation and infected two nurses caring for him, is spurring hospitals and medical associations to develop the first guidelines for what can reasonably be done and what should be withheld.

Officials from at least three hospital systems interviewed by Reuters said they were considering whether to withhold individual procedures or leave it up to individual doctors to determine whether an intervention would be performed.

Ethics experts say they are also fielding more calls from doctors asking what their professional obligations are to patients if healthcare workers could be at risk.

U.S. health officials meanwhile are trying to establish a network of about 20 hospitals nationwide that would be fully equipped to handle all aspects of Ebola care.

Their concern is that poorly trained or poorly equipped hospitals that perform invasive procedures will expose staff to bodily fluids of a patient when they are most infectious. The U.S. Centers for Disease Control and Prevention is working with kidney specialists on clinical guidelines for delivering dialysis to Ebola patients. The recommendations could come as early as this week.   
The possibility of withholding care represents a departure from the "do everything" philosophy in most American hospitals and a return to a view that held sway a century ago, when doctors were at greater risk of becoming infected by treating dying patients.

"This is another example of how this 21st century viral threat has pulled us back into the 19th century," said medical historian Dr. Howard Markel of the University of Michigan.

the medical industrial complex more profoundly broken than the criminal justus industrial complex

theatlantic |  For someone in her 30s, I’ve spent a lot of time in doctors’ offices and hospitals, shivering on exam tables in my open-to-the-front gown, recording my medical history on multiple forms, having enough blood drawn in little glass tubes to satisfy a thirsty vampire. In my early 20s, I contracted a disease that doctors were unable to identify for years—in fact, for about a decade they thought nothing was wrong with me—but that nonetheless led to multiple complications, requiring a succession of surgeries, emergency-room visits, and ultimately (when tests finally showed something was wrong) trips to specialists for MRIs and lots more testing. During the time I was ill and undiagnosed, I was also in and out of the hospital with my mother, who was being treated for metastatic cancer and was admitted twice in her final weeks.

As a patient and the daughter of a patient, I was amazed by how precise surgery had become and how fast healing could be. I was struck, too, by how kind many of the nurses were; how smart and involved some of the doctors we met were. But I was also startled by the profound discomfort I always felt in hospitals. Physicians at times were brusque and even hostile to us (or was I imagining it?). The lighting was harsh, the food terrible, the rooms loud. Weren’t people trying to heal? That didn’t matter. What mattered was the whole busy apparatus of care—the beeping monitors and the hourly check-ins and the forced wakings, the elaborate (and frequently futile) interventions painstakingly performed on the terminally ill. In the hospital, I always felt like Alice at the Mad Hatter’s tea party: I had woken up in a world that seemed utterly logical to its inhabitants, but quite mad to me.

In my own case, it took doctors a long time (roughly 15 years) to recognize exactly what was wrong with me. Along the way, my blood work was at times a little off, or my inflammation markers and white-blood-cell counts were slightly elevated, but nothing seemed definitive, other than some persistent anemia. “Everything’s probably okay,” the doctors would say, or “You have an idiopathic problem,” which is doctor-talk for “We don’t know why you suddenly have hives every day.” They never implied that I was crazy, or seeking attention, or any of the other things you sometimes hear from patients (especially female ones) who have sought a diagnosis for years on end. At the same time, they didn’t believe anything was wrong enough to pursue; frequently they asked whether I was depressed before even doing a physical exam.

To them, I was a relatively fit, often high-functioning young woman who had a long list of “small” complaints that only occasionally swelled into an acute problem, for which a quick surgical fix was offered (but no reflection on what might be causing it). To me, my life was slowly dissolving into near-constant discomfort and sometimes frightening pain—and terror at losing control. I didn’t know how to speak to the doctors with the words that would get them, as I thought of it, “on my side.” I steeled myself before appointments, vowing not to leave until I had some answers—yet I never managed to ask even half my questions. “You’re fine. We can’t find anything wrong,” more than one doctor said. Or, unforgettably, “You’re probably just tired from having your period.”

In fact, something was very wrong. In the spring of 2012, a sympathetic doctor figured out that I had an autoimmune disease no one had tested me for. And then, one crisp fall afternoon last year, I learned that I had Lyme disease. (I had been bitten by multiple ticks in my adolescence, a few years before I started having symptoms, but no one had ever before thought to test me thoroughly for Lyme.) Until then, facing my doctors, I had simply thought, What can I say? Perhaps they’re right. They’re the doctors, after all.

But this essay isn’t about how I was right and my doctors were wrong. It’s about why it has become so difficult for so many doctors and patients to communicate with each other. Ours is a technologically proficient but emotionally deficient and inconsistent medical system that is best at treating acute, not chronic, problems: for every instance of expert treatment, skilled surgery, or innovative problem-solving, there are countless cases of substandard care, overlooked diagnoses, bureaucratic bungling, and even outright antagonism between doctor and patient. For a system that invokes “patient-centered care” as a mantra, modern medicine is startlingly inattentive—at times actively indifferent—to patients’ needs.

To my surprise, I’ve now learned that patients aren’t alone in feeling that doctors are failing them. Behind the scenes, many doctors feel the same way. And now some of them are telling their side of the story.

those thirteen year old incident response plans may fool a lazy auditor, but they won't fool ebola

mcclatchydc |  A Liberian man who arrived by ambulance at a Dallas hospital with symptoms of Ebola sat for "several hours" in a room with other patients before being put in isolation, and the nurses who treated him wore flimsy gowns and had little protective gear, nurses alleged Tuesday as they fought back against suggestions that one of their own had erred in handling him.

The statements came as Nina Pham, a 26-year-old nurse at Texas Health Presbyterian Hospital in Dallas, fought off the Ebola virus after contracting it from the Liberian, Thomas Eric Duncan. The statements by the Dallas hospital nurses were read by representatives of the Oakland, Calif.-based group National Nurses United.

RoseAnn DeMoro, executive director of National Nurses United, said the nonunionized Texas nurses could not identify themselves, speak to the media independently or even read their statements over the phone because they feared losing their jobs. In a conference call, questions from the media were relayed to the unknown number of nurses by National Nurses United representatives, and the responses were read back to reporters.

DeMoro said all of the nurses had direct knowledge of what had transpired in the days after Duncan arrived at the hospital on Sept. 28.

Among other things, they said that Duncan "was left for several hours, not in isolation, in an area where other patients were present."

When a nurse supervisor demanded that he be moved into isolation, the supervisor "faced resistance from other hospital authorities," the nurses said.

They described a hospital with no clear guidelines in place for handling Ebola patients, where Duncan's lab specimens were sent through the usual hospital tube system "without being specifically sealed and hand-delivered. The result is that the entire tube system, which all the lab systems are sent, was potentially contaminated," they said.

"There was no advanced preparedness on what to do with the patient. There was no protocol; there was no system. The nurses were asked to call the infectious disease department" if they had questions, they said.

The nurses said they were essentially left to figure things out for themselves as they dealt with "copious amounts" of body fluids from Duncan while wearing gloves with no wrist tapes, gowns that did not cover their necks, and no surgical booties. Protective gear eventually arrived, but not until three days after Duncan's admission to the hospital, they said.

The nurses' allegations conflict with what hospital officials have been saying since Duncan's admission: that they have strict protocols in place for handling such patients and that a mistake led to Pham becoming infected while she treated him.

The hospital released the following statement after the nurses' comments:

"Patient and employee safety is our greatest priority and we take compliance very seriously. We have numerous measures in place to provide a safe working environment, including mandatory annual training and a 24-7 hotline and other mechanisms that allow for anonymous reporting. Our nursing staff is committed to providing quality, compassionate care, as we have always known, and as the world has seen firsthand in recent days. We will continue to review and respond to any concerns raised by our nurses and all employees."

DeMoro said the nurses came forward and asked Nurses United to publicize their statements out of anger they were being blamed for what had happened to their colleague.

The nurses statements come as an additional 76 health care workers who were involved in the treatment of Duncan are being watched for symptoms of Ebola and as the U.S. Centers for Disease Control and Prevention pledged to improve its response to hospitals in the event of more Ebola cases.

Read more here: http://www.mcclatchydc.com/2014/10/14/243412_dallas-nurses-describe-ebola-hospital.html?&rh=1#storylink=cpy

100-year old ricin found in NIH lab...,

realclearscience |  The National Institutes of Health said it has uncovered a nearly century-old container of ricin and a handful of other forgotten samples of dangerous pathogens as it combs its laboratories for improperly stored hazardous materials.

The agency began an intensive investigation of all its facilities after a scientist in July found vials of smallpox dating from the 1950s, along with other contagious viruses and bacteria that had been stored and forgotten in one lab on the NIH's campus.

Friday, the NIH said in different facilities, it found small amounts of five improperly stored "select agents," pathogens that must be registered and kept only in certain highly regulated laboratories. All were found in sealed and intact containers, with no evidence that they posed a safety risk to anyone in the labs or surrounding areas, the agency said in a memo to employees. All have been destroyed.

They included a bottle of ricin, a highly poisonous toxin, found in a box with microbes dating from 1914 and thought to be 85 to 100 years old, the memo said. The bottle was labeled as originally containing 5 grams, although NIH doesn't know how much was left.

Ricin has legitimate research uses, the NIH said, but was not studied in this lab.

Also discovered were samples listing pathogens that cause botulism, plague, tularemia and a rare tropical infection called melioidosis.

deep defects in medical industrial economics...,

technologyreview | Because of medical insurance, co-pay reductions, and expanded access programs for the uninsured, relatively few Americans pay more than a few thousand dollars per year for even the most expensive drugs. The primary customers in the United States are not patients or even individual physicians, although physicians can drive demand for a drug; rather, the customers are the government (through Medicare and Medicaid) and private insurance companies. And since the insurer or government is picking up the check, companies can and do set prices that few individuals could pay. In the jargon of economics, the demand for therapeutic drugs is “price inelastic”: increasing the price doesn’t reduce how much the drugs are used. Prices are set and raised according to what the market will bear, and the parties who actually pay the drug companies will meet whatever price is charged for an effective drug to which there is no alternative. And so in determining the price for a drug, companies ask themselves questions that have next to nothing to do with the drugs’ costs. “It is not a science,” the veteran drug maker and former Genzyme CEO Henri Termeer told me. “It is a feel.”

There are inherent problems with a system where the government is one of the biggest payers, and where doctors, hospitals, insurers, pharmacy benefit managers, drug companies, and investors all expect to profit handsomely from treating sick people, no matter how little real value they add to patients’ lives or to society. Drug companies insist that they need to make billions of dollars on their medicines because their failure rate is so high and because they need to convince investors it is wise to sink money into research. That’s true, but it’s also true that the United States, with less than 5 percent of the world’s population, buys more than 50 percent of its prescription drugs. And it buys them at prices designed to subsidize the rest of the industrial world, where the same drugs cost much less, although most poor governments can’t afford them at even those lower prices.

Still, we have to ask: When is the high price of a drug acceptable? Perhaps it is one thing when Vertex charges $841 for two pills a day—every day of a patient’s life—for medicine that will save that life, and quite another when Sanofi offers a cancer drug that is twice as expensive as its alternative but offers no obvious advantages.