Homeopaths are offering “alternative vaccinations” which doctors say could leave patients vulnerable to potentially fatal diseases, a BBC investigation has found.
Three practitioners admitted giving patients a homeopathic medicine designed to replace the MMR vaccine.
Inverness-based Katie Jarvis said she only offered “Homeopathic Prophylaxis” to patients who expressed an interest.
But the discovery has prompted a shocked reaction from doctors.
(…) However, the BMA’s director of science and ethics, Dr Vivienne Nathanson, said: “Replacing proven vaccines, tested vaccines, vaccines that are used globally and we know are effective with homeopathic alternatives where there is no evidence of efficacy, no evidence of effectiveness, is extremely worrying because it could persuade families that their children are safe and protected when they’re not.
“And some of those children will go on to get the illness, and some of those children may go on to get permanent life-threatening sequelae, or even to die, and that’s a tragedy when the family think they’ve protected their children.”
(…) NHS Highland – the health board covering Inverness – said it was considering withdrawing funding for homeopathic preparations.
Archive for the 'Healthcare' Category
Tags: Homeland Security, Quackery
Tags: Homeopathy Quackery
Hundreds of members of the BMA have passed a motion denouncing the use of the alternative medicine, saying taxpayers should not foot the bill for remedies with no scientific basis to support them.
(…) Dr Tom Dolphin, deputy chairman of the BMA’s junior doctors committee in England told the conference: “Homeopathy is witchcraft. It is a disgrace that nestling between the National Hospital for Neurology and Great Ormond Street [in London] there is a National Hospital for Homeopathy which is paid for by the NHS”.
(…) In February a report by MPs said the alternative medicine should not receive state funding.
The Commons science and technology committee also said vials of the remedies should not be allowed to use phrases like “used to treat” in their marketing, as consumers might think there is clinical evidence that they work.
In evidence to the committee, the Royal Pharmaceutical Society of Great Britain said there was no possible reason why such treatments, marketed by an industry worth £40 million in this country, could be effective scientifically.
Tags: AHRQ, GTT, Medical errors, Patient Safety
It makes me happy to drill down into a NZ government healthcare-safety website to find a link to Atul Gawande’s TED Talk How do we heal medicine? That is just an indicator, but a positive indicator, that NZ is paying attention to developments in methods to radically improve medical safety. For those who are new to this topic, this earlier post links to important resources: How to Stop Hospitals From Killing Us.
If we can measure safety effectively we have a much better chance of improving outcomes. Here’s how the NZ HQSC describes the Global Trigger Tools:
The Commission is developing a work programme to help implement the Global Trigger Tools programme in New Zealand.
The Global Trigger Tools* programme is an international initiative to reduce patient harm caused by errors in hospitals. Currently most health service providers rely on voluntary reporting of errors to identify problems in their systems, however overseas research found that only 10-20 percent of errors are ever reported. While in the vast majority of cases these errors did not result in patient harm, tracking these events would help identify where improvements should be made.
The Global Trigger Tools programme takes a different approach to error reporting, rather than relying on people reporting errors, it analyses random samples of patient records looking for ‘triggers’ which indicate an error has been made. The information gained can then be used to improve the quality and safety of the services provided.
Carol Haraden is the Vice President of the Institute of Healthcare Improvement (IHI). IHI developed the Global Trigger Tool which the Commission is encouraging all DHBs to implement. The Commission is working to publish helpful resources to assist with implementation. In the short AV below, Carol is interviewed at the Asia Pacific Forum (APAC) on patient safety and asks why clinicians aren’t using a standardised approach to patient safety issues. She also talks about the importance of team-work in achieving improved patient safety.
The Global Trigger Tool has a focus on team-work as the methodology requires medical record reviews to be carried out by a team of trained reviewers who have a clinical background (usually nursing or pharmacy). This is a simple, validated, and cost effective methodology and has been widely used to identify, quantify and track patient harm.
The NZ implementation guide is excellent: The Global Trigger Tool: A Practical Implementation Guide for New Zealand District Health Boards [PDF, 1MB]
“Ground Zero” for evaluation of the effectiveness of this methodology is back at IHI: IHI Global Trigger Tool for Measuring Adverse Events. Here you can find a large resource library, from Training Record Sets to translations in Danish, German, Swedish.
The use of “triggers,” or clues, to identify adverse events (AEs) is an effective method for measuring the overall level of harm in a health care organization. The IHI Global Trigger Tool for Measuring AEs provides instructions for training reviewers in this methodology and conducting a retrospective review of patient records using triggers to identify possible AEs. This tool includes a list of known AE triggers as well as instructions for selecting records, training information, and appendices with references and common questions. The tool provides instructions and forms for collecting the data you need to track three measures:
- Adverse Events per 1,000 Patient Days
- Adverse Events per 100 Admissions
- Percent of Admissions with an Adverse EventFor more general information on Trigger Tools and how to select the appropriate one, see the Introduction to Trigger Tools page.
In Measuring Safety at the IHI Safety First Blog, Frank Frederico summarized the recent Health Affairs paper: ‘Global Trigger Tool’ Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured. In brief an expert review of closed patient charts by, typically, nurses and pharmacists appears to be much more effective than automated review — ten times more effective.
Measuring safety is crucial to improving health care, yet we still struggle to do it well.
Much of the challenge lies in safetys very nature: it is, inherently, a non-event—the absence of harm. So by necessity we focus instead on measuring what might be called ‘non-safety,’ usually in the form of harmful events. Fewer of these harmful events, we assume, means a safer health care system.
But which events do we count? How do you tally non-safety?
Our answer to that simple question is hugely consequential. Some efforts focus on infections, for instance. These are crucial harm events, but they are not the whole picture. Their absence does not, in and of itself, tell us that care delivery is safe.
At IHI, we’ve developed a freely available method of determining harm events that we call The Global Trigger Tool. Its advantage is comprehensiveness. Its drawback is time-intensiveness. We believe it’s a trade-off worth making. Here’s how the method works, as described in a recent Health Affairs paper:
‘Closed patient charts are reviewed by two or three employees —usually nurses and pharmacists, who are trained to review the charts in a systematic manner by looking at discharge codes, discharge summaries, medications, lab results, operation records, nursing notes, physician progress notes, and other notes or comments to determine whether there is a ‘trigger’ in the chart. A trigger could be a notation indicating, for example, a burn, a fall, or a reaction to a medication. Any notation of a trigger leads to further investigation into whether an adverse event occurred and how severe the event was. A physician ultimately has to examine and sign off on this chart review.’
We tested this system against other widely used methods to detect adverse events, and the results were stunning. The trigger tool detected 354 adverse events, while tools based on automated chart review fared far worse. The Agency for Healthcare Research and Quality’s (AHRQ) Patient Safety Indicators detected only 35 adverse events. The hospitals’ voluntary reporting systems? Just four.
You’ve all heard the old iceberg trope – 10 percent above water, 90 percent below. Well here it is, in sobering statistics. And those errors that occur below the water line of measurement aren’t actually invisible – not to patients, not to their families, and not to providers or to the functioning of our health care system.
The trigger tool is less time intensive than some other chart review methods, but as I mentioned earlier, it is not as cheap as automated methods such as AHRQ’s Patient Safety Indicators. Manual review simply takes more time. There is no way around that.
But nor is there a way around the danger of missing so many adverse events. Think about what other audits you conducting at your hospital that may be just as time-intensive. Surely, safety should rate the same level of attention and commitment.
So we want to hear from you:
How do you measure harm in your organization?
Do you believe that you are capturing the entire scope of harm?
The good news, from our perspective, is that hospitals and regulators are increasingly using the trigger tool to identify the broader universe of adverse events. We will keep working to continue this trend—because only by facing the reality of adverse events can we truly address them.
In the UK, The Acute Trigger Tool is the approved UK version of IHI Global Trigger Tool. Again, lots of resources from the UK NHS Institute for Innovation and Improvement.
If you have access to JAMA Journal of the American Medical Association you can read Deciphering Harm Measurement, May 2012:
Improvement in health care quality and safety can be notable when measurement criteria are clear, evidence is strong, and policy and interventions are focused. Despite this potential, progress in reducing patient harm in hospitals has been slow.1 In an effort to catalyze progress, the Department of Health and Human Services (HHS) is funding a national program, Partnership for Patients (P4P), with the ambitious goal of reducing “preventable hospital-acquired conditions” by 40% by 2013, focused initially on 9 complications.2 Although the program’s goal formally includes only preventable harm, the HHS notes “the Partnership will target all forms of harm” and provide guidance to hospitals for reducing “all-cause harm.” Simultaneously, the list of “serious reportable events” for which the Centers for Medicare & Medicaid Services will modify physician and health care institution payment is increasing. However, delay in defining a measurement strategy for harm has slowed progress and has created confusion. The need to reach consensus on robust, pragmatic measures for assessing and tracking harm rates has therefore become urgent.
Next we’ll look at what Australia is doing.
Yesterday I listened to the Dec 18th Commonwealth Club lecture by Donald Berwick, M.D., Former President and CEO, Institute for Healthcare Improvement; Former Administrator, Centers for Medicare and Medicaid Services. I have never heard Berwick talk before. So I came to the lecture with no priors, to see if his recommendations made sense. I was impressed. Berwick reflected all of the recent research that I have been reading on how to dramatically improve quality. Because quality improves outcomes, reduces hospital stays, reduces interventions, higher quality is really the only sane route to lower costs. It also happens to save a lot of lives and eliminate a lot of misery.
Here’s a fragment of Bob Sutton’s commentary on Berwick’s resignation address.
Before coming to Washington, the organization he led, a small non-profit called the Institute for Health Improvement, organized and guided an effort in American hospitals that — by doing simple, evidence things like hand washing, raising the bed when people are on a respirator, and other small but effective things — saved more than 100,000 lives by some estimates. This little non-profit recruited over 3000 hospitals that had over 70% of the beds in the U.S. to participate in this effort to reduce preventable deaths.
Obama, recognizing his greatness, appointed him as head of the Centers for Medicare and Medicaid Services. Or he tried to. Our do nothing — or actually do nothing but screw the other side — Congress opposed his appointment, so Obama did one of those sneaky interim appointments that Berwick to keep the position for 17 months before being forced out. The New York Times Joe Nocera did a great piece on him, check it out.
The thing I would especially emphasize is that Berwick is not and has never been about ideology, he is about effectiveness and cost-cutting is central to everything he does and advocates.
You can access the audio of his lecture here, or via iTunes subscription to the Commonwealth Club Radio Show.
Tags: Antibiotic resistance, HAI, MRSA
Most of what I read on antibiotic resistance, hospital-acquired infections (HAI) are very depressing. Humanity seems to be an accelerating train — the destination a pre-antibiotic world — where surgery is often a death sentence.
Today I read of a possibly optimistic development: Breaking the bacteria barrier. The IBM Research hydrogel uses a novel attack by rupturing the bacteria’s membrane, rendering it completely unable to regenerate or spread. The researchers envision the first healthcare application to be surface decontamination. That’s very important in infection control, so it’s not a small thing if it works as they hope. The following image comes from IBM Research Hydrogels TUMBLR blog, where you can find more background on this research, and hopefully updates as they are announced.
I’ve just followed @IBMResearch — there will be a a hydrogel chat in a couple of weeks. I’ll be looking for that announcement on Twitter/Tumblr. Since this is the corporate research twitter there will probably be a lot of traffic. I will suggest a #hydrogel hashtag to at least give us a chance of following developments.
It isn’t obvious to me how bacteria will develop resistance to this mechanism of action. Am I missing something there? The IBM team has looked at an injectable application of the gel – e.g., at the site of an infection.
What we all are hoping for is that this research could lead to the equivalent of a broad spectrum antibiotic effective against the growing number of super-bugs.
If you read German, the full paper is available here: Broad-Spectrum Antimicrobial and Biofilm-Disrupting Hydrogels: Stereocomplex-Driven Supramolecular Assemblies.
BTW, CDC has redefined HAI to be “Healthcare-associated infections” which is more accurate.
Tags: Medical errors
Dr. Marty Makary tweeted this survey reported by Medscape Today:
Have you ever been caught between loyalty to another physician whose skills you don’t respect, and wanting to warn a patient if you knew they were scheduled to have a procedure performed by that physician?
More than 24,000 physicians answered this question in Medscape’s 2012 Top Ethical Dilemmas Survey Report.
Dr. Makary is the author of Unaccountable/ What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care.
See this earlier post How to Stop Hospitals From Killing Us for more.
Roughly a quarter of all hospitalized patients will be harmed by a medical error of some kind. If medical errors were a disease, they would be the sixth leading cause of death in America—just behind accidents and ahead of Alzheimer’s.
Economist Tyler Cowen highlighted one of those “isn’t that obvious?” observations by physician/senator Dr. Tom Coburn (conservative R-OK)
‘If I had the magic wand,’ he told me, ‘I’d change how we pay for Medicare.’ That’s a common enough sentiment, but the policy Coburn has in mind is a bit more radical than what’s typically offered in Washington.
‘I’d change all physicians to time instead of fee-for- service,’ he says. ‘What we’re doing with fee-for-service, and most people don’t realize this, is when you go to the doctor, they have this pressure to see X number of patients a day to meet their numbers.’
If we cut payments to doctors, Coburn says, ‘they’re going to cut the time they spend per patient. When a patient is in a room and you haven’t used your skills as a physician to really listen, you walk out and cover that absence of time by ordering tests. So if you say here’s all the hours we’ll pay for if you’re a Medicare doctor, and we can actually audit that time, doctors would have to demonstrate proof that they’re spending this time with patients.’
That wasn’t, I noted to Coburn, a policy that appeared in any of the bills he had sponsored, a fact he acknowledged with a laugh. ‘I didn’t put that in there,’ he said, admitting the idea has little political support. ‘It’s just something I’ve thought about a long time. Nobody should be seen for less than 20 or 30 minutes if you’re doing this properly. And if I knew I was going to get paid for my time I wouldn’t be in a hurry to see the next patient.’
Here are further ideas on Medicare reform.
Fee-for-service cannot be the basis for any sort of optimal medical system. Most of the managed-care organizations that have emerged have compensation based first on salary, secondly on performance (results). Measuring results is extremely tricky, not least because of physician patient-selection bias. But I think it can be done (it’s just math and sufficient data).
Bisphenol A (BPA) found not harmful, yet again — so why did so many reporters and NGOs botch coverage, yet again?Published November 27, 2012 Biology , Healthcare 2 Comments
Jon Entine recently published an absolutely terrific review of the ongoing fight between evidence-based science and the anti-science fear mongering against BPA. Jon opens with this:
One of the most disturbing trends in science reporting is what The New York Times’ Andrew Revkin calls “single-study syndrome”— the increasing tendency of reporters and non-governmental organizations (NGOs) to trumpet research that supports a pre-determined perspective, no matter how tenuous—or dubious—a study might be.
and closes with this:
Why, after such a massive accumulation of evidence do activist NGOs, many reporters and even some scientists continue to reject the emerging, evidence-based scientific consensus? “At this point,” one prominent government scientist told me, “with all the recent studies in hand, calling BPA harmful and dangerous, that’s just mass hysteria.” Clinicians call this apophenia—a neurological condition in which people insist they see meaningful patterns or connections in contradictory or random data.“There are people who believe in the low dose effect of BPA and will always believe its disruptive effect, regardless of the evidence,” Dr. Gray told me. The ‘BPA-is-harmful’ crowd appears impervious to peer reviewed studies,” he added. “That’s a religious position. But as scientists and regulators, we have to go where the data takes us.”
You will be rewarded by reading Jon’s entire essay. Now. I promise you will better understand the source of all the alarming headlines you see about the dangers of “endocrine disruptors” and BPA.
This Atlantic essay by Shannon Brownlee & Joe Colucci offers an excellent survey of 'patient choice'. The authors begin with this:
In most industries, quality-improving and cost-cutting innovations don’t sit around for years while people keep muddling through with old technology. When an innovation is ready for widespread use, it disrupts the market, whether the market wants it or not. In the process, some entrepreneur usually makes a killing.
That process hasn’t worked in healthcare, though — and because of that, we have a whole set of rarely-used innovations that are ready for large-scale implementation, and that could start saving money today. Those technologies include simple things like broader use of generic drugs, which can reduce pharmaceutical costs significantly; and better hand washing, which reduces the transmission of disease within hospitals and doctor’s offices. They also include more complicated interventions like Lean management, which has been implemented successfully at hospitals like Virginia Mason Medical Center in Seattle and Thedacare in Wisconsin, to make their care processes more efficient by cutting out useless steps.
The habit of assuming the doctor knows best has created a system where huge numbers of patients aren’t getting the treatment they would have chosen if they were fully informed.
Then there’s shared decision making, which helps patients be better informed about their treatment choices and make better decisions — and might be the most promising of the bunch in terms of improving care and reducing spending.
Shared decision making is a way of dealing with the tough questions posed by “preference-sensitive conditions” — conditions where there are multiple treatment options, and none of those options is clearly better than the others. That includes conditions like arthritis in knees and hips, low back pain, stable angina (chest pain from heart disease), and early-stage prostate and breast cancer. (Obviously, it doesn’t include emergency conditions like heart attacks and hip fractures, or conditions where there is clearly only one treatment.)
Deciding on a treatment for preference-sensitive conditions involves weighing a variety of risks and possible benefits, and different patients will end up making different “right” decisions because they have different values and preferences. The best example here is women with early-stage breast cancer. They can choose lumpectomy (surgery that preserves the breast) or mastectomy (which removes it entirely). The two options are equally good in terms of reducing the risk of dying of breast cancer, but they require different kinds of follow-up and different women prefer one over the other.
Making such decisions means that patients must have the relevant information about all their treatment options, and doctors must understand their individual patients’ preferences — basically, what they want from treatment. But too often, patients only hear about one treatment option, the one the doctor usually uses — and doctors routinely assume they know what their patients want without actually asking them. And in many cases, the doctor is wrong.
This habit of assuming the doctor knows best has created a system where huge numbers of patients aren’t getting the treatment they would have chosen if they were fully informed. It also means that hundreds of thousands of patients are going through surgery that wasn’t really worth it, and that they wouldn’t have chosen had they understood their options.
Don't miss John Cochrane After the ACA: Freeing the market for health care
(…) So here we have the government forcing small size in order to boost competition with one hand, stopping entry to protect hospitals from competition with another, trying to force larger “networks” through “Affordable Care Organizations” to obtain the needed economies of scale with the third, but laws preserving doctor independence with the fourth.