Archive for the ‘DRUG and LAWSUITS’ Category

HEAD INJURY – WHY NOT WEAR THE HELMET

Thursday, July 12th, 2007

Recently, during a Fourth of July parade, many bikers, cyclists, gymnasts, cheerleaders, rollerskaters, Shriners’ clowns, speed-skaters, and even horseriders were watched with such intensity…and were applauded for their acts, high flying or racing speed. BUT……..Why not wear a helmet?

Some states have passed and then repealed helmet laws. There has been some emphasis on kids with bicycles to wear helmets, and some push to wear helmets during down-hill skiing. BUT…..Why not wear the helmet always?

Is it a personal right NOT to wear a helmet? Is it a business right then for taxpayers, insurers, employers, disability companies and worker comp programs to refuse coverage retrospectively for such injuries and morbidity when someone does NOT wear a helmet? What about a seat-belt? What about smoking, drinking, obesity, and lack of exercise? Sounds far fetched?

Well, back to the parade…..

The Emergency Departments see generally over 2 million head trauma victims annually in the United States.  It is the leading cause of death in persons under 25 years old, with over 50,000 persons dying yearly from head injury.

Head injury crosses all boundaries of socio-economics, ethnicity, financial burden, and coverage.  Just ask the attorney that fell from the bus he was watching a parade from…a little too much partying possibly…Ask his wife who was unrecognized by this smart man after hitting his head.  Life as it was…over…New rules, new learning, new start – ALL difficult to say the least.  Career, family, dreams, and hopes all snuffed due to the head injury.

Some patients have intra-cranial bleeding from their head injury, which is about 5-10%.   This means there is bleeding either in the brain itself, or around the brain under the skull.  Each of the types of bleeding is extremely serious.  Some do not need surgery, while other types of head injury with bleeding inside the skull require immediate life-saving procedures and surgeries. 

High risk groups for “closed” (no external injury) head injury that need a CT scan, which now is the standard, are kids under 6 months, elderly, persistent vomiting, neurological or mental changes, alcohol abuse or overuse, prolonged loss of consciousness and those on blood thinners.  The medical legal world has driven the doctors to scan more often defensively, even with minor head injury.  This has been pushed by successful litigation for what appears minor, only later to be a significant injury.

Even the NFL has now taken up the banner.  It is evident now that boxers and football players with repeated or recurrent head injuries have shown brain disability later in life.  Most of the athletic associations understand now that head injury, even minor, is not to be taken lightly.   Even many of the “rough and tough” rodeo cowboys now wear helmets with the rodeo association.  The bronco-busters are leading the pro charge.

So what’s up with the ultimate boxing and cage fighting until loss of consciousness?  Should insurers, payors, and hospitals be forced to insure these programs and their victims? 

Long term complications of concussion, (which ranges from a confusion with loss of consciousness to complete coma)  are many.  Memory difficulties exist, and may stay persistent.  Dizziness, a general feeling of weakness or lack of energy may continue for months to years.  Headache is common, as well as a problem of focusing on projects or things that require intense thought.  Amnesia, or ability to remember is certainly a problem many victims of head injury encounter.  This retrograde (backwards) memory loss can be devastating.  Thus the attorney’s wife….sobbing….and wondering….

Generally there are three classes of initial head injury in evaluation and prognosis.  They are:  mild, moderate, and severe.  This category is really of doctor’s category based on an initial scoring designed by Glascow.

castMD in a previous post discussed more about head injury.  Please see the following link if you wish to read more about concussion and sports

http://www.castmd.com/?p=93

But head injury is a very serious matter…So teach your kids to wear their helmets by wearing yours.  Consider the no helmet-no activity rule for this. 

As for what the future will bring for insurance coverage for dangerous behavior regarding helmets is still up in the air…..but many insurance companies require a rider or no insurance coverage for trampolines now…..too many broken necks and spinal cord injuries!

I remember the little boy as he was lying there.  Absolutely beautiful 4 year old.  Unconscious.  Comatose.  Scheduled for long-term care preparation and surgeries.  No sign of external injury.  “Just a closed head injury…..”

“SICKO” – WILL IT HELP MAKE THE DIAGNOSIS AND TREATMENT?

Monday, July 9th, 2007

AFTER LISTENING THIS PAST FEW DAYS TO SOME NEWS, CASTMD FIGURED THE SYSTEM IS TOO BROKEN NOT TO COMMENT.  MIKE MOORE’S DOCUDRAMA OF THE U.S. HEALTHCARE SYSTEM IS AT LEAST A STARTING POINT…AGAIN….A NEW KIND OF DOCTOR EXPOSED

A FRIEND OF MINE SAVED A PATIENT’S LIFE.   IN SURGERY, THE PERSON ALMOST DIED. THIS ANESTHESIOLOGIST WANTS TO GET PAID BY THE PATIENT’S INSURANCE COMPANY. SOUNDS SIMPLE?

THE PATIENT HAD TO BE TRANSFERRED FROM THE SMALLER HOSPITAL TO A TERTIARY CENTER (A LARGER TEACHING TYPE HOSPITAL) AND LATER UNDERWENT ANOTHER SURGERY. NOW THE INSURANCE COMPANY WILL NOT PAY THE FIRST HOSPITAL AND THE ANESTHESIOLOGIST. THEY DEMAND MORE PAPERWORK, SAYING IT WAS THE SAME SURGERY. SO THE BATTLE OF HEALTHCARE PAYMENTS GOES ON! GENERALLY, DESPITE THE ONLINE DIRECT SUBMISSION OF BILLING TO MEDICAID, MEDICARE, AND OTHER INSURANCE COMPANIES, PAY IS SLOW.

WHAT HAPPENS THEN, IS THE PATIENT GETS BILLED, THE EXPLANATION OF BENEFITS GOES OUT AND EVERYONE INVOLVED IS SENDING DOCUMENTS AND PHONECALLS TO EVERYONE ELSE. SO IT GOES. SO MUCH LOST EFFORTS, EXPENSES, AND WORK…TO GET PAID.

ALL THAT MONEY COULD BE FOR HEALTH AND WELLNESS AND PREVENTION. INSTEAD YOU HAVE FAMILIES BEING BANKRUPTED BY MEDICAL BILLS. THIS HAS BECOME ANOTHER CREDITOR ATTACKING YOUR CREDIT RATING, YOUR PROPERTY, YOUR LIVELIHOOD, AND YOUR HARD-EARNED DOLLARS. MANY HOSPITALS HAVE LAW FIRMS NOW FILE LITIGATION AND SUE THE PATIENTS FOR PAYMENT.

WE SPEND THE MOST ON HEALTH IN THE INDUSTRIALIZED WORLD, YET WE HAVE HIGH INFANT MORTALITY, A SHORTER LIFE EXPECTANCY, AND NEARLY 45 MILLION KNOWN ABOUT PERSONS WITHOUT ANY INSURANCE COVERAGE TO ADEQUATELY PROTECT THE FAMILY OR THEMSELVES.

THE DIRECTOR OF THE G.A.O. (GENERAL ACCOUNTING OFFICE) WAS ON TV THE OTHER DAY. HE SAID IT IS TOO LATE IF WE DO NOT CHANGE NOW. HE IS IMPORTANT. HE IS THE UNITED STATES’ CPA BASICALLY. HE IS MEETING WITH BUSINESS LEADERS, COMPANIES, AND OFFICIALS TO TRY TO GET THE MOMENTUM UP TO CHANGE HOW WE DO THINGS. HE SAID THAT WITH THE BABY-BOOMERS COMING “ON LINE” IN JANUARY 2008, THE GOVERNMENT HAS CREATED A SYSTEM OF INCOMPATIBLE EXPENSE. WITH MEDICARE, MEDICAID, AND SOCIAL SECURITY FOR THE BOOMERS, THE SYSTEM WILL BUST.  SOON!   2020 OR SOONER!   WHY?  HE HAS GIVEN UP ON CONGRESS !!!

IF YOU ADD ON THE NUMBER OF MANDATED ER CARE OF ILLEGAL IMMIGRANTS GOING TO THE EMERGENCY ROOMS, PLUS THE UNDERINSURED, AND THE UNINSURED – IT IS EASY TO APPRECIATE THE PROBLEM.  MANY HOSPITALS’ ERs HAVE CLOSED.  SOME HOSPITALS ARE BEING SOLD FROM NOT-FOR-PROFIT TO FOR-PROFIT SYSTEMS.

WHAT ARE YOU DOING TO HELP TALK IT UP ABOUT HEALTH INSURANCE RATES, HEALTH INSURANCE, AND THE COSTS.  

NO FAMILY SHOULD BE FORCED INTO BANKRUPTCY BY HEALTH ISSUES……

EMERGENCY ROOM VISITS – ILLICIT DRUG ABUSE TOP TEN

Monday, July 2nd, 2007

poppy.gifAccording to D.A.W.N. which stands for Drug Abuse Warning Network the top ten Emergency Department visits were surprising. Although this list is published openly, it does run about 1-2 years behind.

COCAINE………………………..OVER 448,000

MARIJUANA……………………..OVER 242,000

HEROIN………………………….OVER 164,000

meth-1.pngMETHAMPHETAMINE…………..ALMOST 109,000

ECSTASY (mdma)……………..ALMOST 11,000

PCP………………………………OVER 7500

INHALANTS……………………..OVER 4300

HALLUCINOGENS……………….OVER 3700

LSD………………………………OVER 1800

GHB………………………………OVER 1800

This data is from a reporting system in the United States. Many times, GHB for instance, is gone from detection upon arrival to an Emergency Room. Many inhalants cause death, therefore do not show up in the Emergency Room, but rather the Coroner’s venue. Many times the data is also regionally directed, for instance, in high methamphetamine areas, illicit use might be seen higher in the corresponding Emergency Departments.

To round out this medical commentary today, the United States still has these top ten killers. ecg_evol1.gif

This data is from the 2004 National Center for Health Statistics, the latest full database.  Prevention is the key in almost all of these killers.  With the severe childhood obesity concern in the United States, these data may get thrown in the air, with new issues on top.  For instance, diabetes and asthma may replace the first and second positions due to the issues of childhood health management in general.

HEART DISEASE……………………………………………………………………………27.2%

CANCER…………………………………………………………………………………23.1

CEREBROVASCULAR DISEASES…………………………..6.3%

CHRONIC LOWER RESPIRATORY DISEASES…………5.1%

UNINTENTIONAL INJURY…………………………..4.7%

DIABETES MELLITUS……………………………..3.1%

ALZHEIMER’S DISEASE………………………2.8%

INFLUENZA AND PNEUMONIA……2.5%

KIDNEY DISEASES……………….1.8%

SEPTIC CONDITIONS……….1.4%

CHEESE – MARKETING HEROIN FOR YOUR KIDS “SAY CHEESE”

Tuesday, June 26th, 2007

cheese-drug.jpgAs part of my background in pharmacy, emergency medicine, and toxicology, my eye is geared toward new illicit “marketing styles.” One of the latest, yet as usual, older than you think, is “cheese” heroin. This “starter pack” of heroin is REALLY heroin…the DEADLY kind of heroin…the good old toxic illicit heroin.

The difference is in the making of it. The manufacturers of the illicit drug geared for the teens is the mixture of heroin and Tylenol PM©. This multi-drug cocktail of acetaminophen, diphenhydramine (better know as brand name benadryl © and other companies brands) and of course heroin creates a deadly risk. Each item in this mix can be deadly.

As the famed Paracelsus, an earlier father of poisoning stated, “It is not the agent, but rather the dose of the agent. And everything therefore is a poison.”

Acetaminophen remains one of the most toxic poisons if taken in overdose and is the lead cause of death for many years in Europe, while diphenhydramine is again a unique poison in overdose. The anticholinergic side-effects of the drug in overdose creates elevated deathly temperature rise, hallucinations, cardiac instability, agitation, and even death. Heroin for years now continues to plague not only the U.S., but nations around the world. It has enormous addictive potential and leads to severe toxicity, criminality, and occasional deaths on the streets.

Say “Cheese” is a deadly form of a multi-drug extravaganza geared to entice, to addict, and to control your kids. Already in the last 1-2 years, especially in the Texas market, over 20 deaths have occurred. The product appears like Parmesan cheese in structure, yet kills with a vengeance.

paremsan
(grated parmesan)

Say “Cheese” is usually snorted. Why do drug abusers snort? It is because the absorption rate is good. But I have seen those individuals with chronic cocaine abuse, literally rot the nasal septum out…”look Mom, no septum!”

Post-mortem toxicology tests will reveal the deadly three drugs in this mixture…heroin, diphenhydramine, and acetaminophen.

“Cheese” is not a starter-kit for drug use. “Cheese” is a start-kit for deadly teenager activity.

cheese-drug.jpgSAY “CHEESE” MAY BE THE LAST PICTURE TAKEN……..

HUG YOUR KIDS TODAY!

AARP article misses the boat – DRUG SAMPLES AND DRUG REPS – MAYBE NOT SO BAD – BUT LIMIT THE DIRECT-TO-CONSUMER ADS and LAWSUITS

Tuesday, June 5th, 2007

A recent article in the AARP Bulletin highlighted an email of a drug company's inside commentary on drug representatives and their impact on physicians' practices.  Congress was on this subject of how doctors obtain information years ago, and rather than mandating legislation, the Pharma Industry limited themselves.  Now the irony here is that, all the Pharma Industry now advertises the millions and millions of dollars for their new drugs on television, cable and non-cable, radio, and the print media.  How many ads of erectile dysfunction have you seen or watched in the last few years?  What about allergy drugs?  Those ads seem to be everywhere also.

Meanwhile, most doctors get some of their information from drug company representatives.  The doctors of yesteryear were wined and dined – alot.  But all that has changed.  Company meetings for continuing medical information and education are sponsored for cost.  However, the rules are tight.  No trips to Hawaii have ever been offered to me, in 25 years or so.

Now the medical appliance industry, like the artificial hips, pacemakers, etc., are not included in the Pharma SELF-imposed rules.  This industry works like many others.  Recently my awareness was stretched when a person told me ALL hundreds of employees of a beer industry were wined and dined, golfed, and brought to a city with alot of casinos!  All on the company.  And recently a marketing company took hundreds of employees to another city for 3-4 days, for their needs.

Now, most doctors do like to see drug representatives.  We do get good and current information from the reps.  If the doctor has a brain, he or she will and can challenge the drug rep with his product, his information, and his competition.  This is good information.

Literally, thousands of patients through the years have asked for "Any free samples?" Many times we can accomodate some starter paks of medicines that have been given to us by the pharmaceutical representatives.  Most clinics get some samples for patients.  According to a recent study over 75% of clinics get free samples.  Many times the reps will sponsor quick to the point luncheons.  Some doctors join company panels to discuss the highlights and controversies of new therapy.  So, what is the big deal?

Most pharmaceutical reps are good people.  Most earn their living by providing information currently and timely.  Most doctors are good people.  Most earn their living by providing good patient care.  Most patients are good people.  Most enjoy and sincerely appreciate a "few samples" to start their drug regimen.

Now, with the costs of drugs so high, and the pressure on the drug companies to limit free samples or starter paks, it would seem to be soon – a policy that will be forced out.  This will be a loss for the underinsured, uninsured, family of four parents, and others that look at the costs in general of healthcare and delay or eliminate their prescription all together.

The billions of dollars spent on "direct-consumer-advertising" that is endorsed by the FDA and other federal, state, and societal organizations is the first place to cut drug costs.  Those ads drive the physician by patient requests.  Get rid of direct to consumer advertising.  Next, get rid of the massive class action suits against all the companies.  The U.S. has driven the vaccine industry out of the U.S. and the drug making is not far behind.  If the vaccine shortage concerns did not awaken some fear in you, this should.

So, soon, patients will say good bye to free samples, free starter cost reduction cards, and reduced up to date physician information.

As for me, trips, rock n' roll collections, and tennis racquets have not crossed my desk….And to say they do is just crazy by a biased author.  And some of the doctors will stay "chummy" with professional colleagues in the pharmaceutical representative business.  Some might call that professional interaction and ethical education…

SALT USE AND CARDIOVASCULAR DISEASE AND HYPERTENSION

Monday, May 28th, 2007

Stroke and other cardiovascular diseases are linked closely to high blood pressure.  In many studies, hypertension is a strong predictor of these severe problems, including stroke (brain attack), congestive heart failure, and even myocardial infarction (heart attack).

The importance of salt intake (sodium chloride) with regard to high blood pressure is well linked.  Most of these studies have been a type of case control showing high probable causal relationship.  Some other studies have shown that higher salt intake predicted the higher incidence of cardiovascular diseases over time.

But a recent published and peer reviewed study, with randomized NON-hypertensive persons, about 3000 of them, has put a strong lock on this issue.  In the study, persons were given about 2.6 gms or 2.0 gms of salt daily.   Another group of placebo was a control also.  The groups were followed out to 18 months or 36-48 months. Then all the groups (cohorts) were followed over the next 10-15 years!

There was a remarkable 30% (approximate) lower incidence of cardiovascular events during this period.  This finding was controlled for age, body mass, sex, ethnic origin, and initial blood pressure – when compared to the placebo group. 

We have long known this concern of salt and high blood pressure and other cardiovascular diseases.  Even back in about 1985, the World Health Organization recommended the salt intake to be reduced to about 5 grams per day. 

In "Westernized" countries, bread and processed foods account for the great majority of salts in the diet, with personal use being about 15-20 %.  In many developing countries however, the personal use is the burden of salt.  Some countries have tried to "legislate" salt reduction, however most of the time, this effort turns to "voluntary" agreement programs with good intent, rather than hard legislation.  More efforts of education and the reason for limiting salt intake should be forwarded by all the main agencies such as the American Heart Association (AHA), the American Diabetes Association (ADA), and others that take the lead to limit cardiovascular disease, morbidity, and mortality.

So think about it.  Should we legislate the prepared foods, soda and beer, snack, eat 'n run, cafe, restaurant, and bar industries to limit the salt in their products?  Dear ol' Mom probably had it right when she said, "Not so much salt!" 

So next time you pick up the product, do a salt survey.  Remember less that five grams a day is highly recommended, while 2 grams a day really makes a difference in your actual risk.  The debate appears to be over.  Salt can take a toll.  Be a wise shopper and a wiser eater. 

Salty popcorn with butter anyone?  Remember, more fiber, less salt, less trans-fats….Yuk!

ER – CRITICAL ENCOUNTER OR DEATH IN FRONT OF YOUR EYES

Wednesday, May 2nd, 2007

After yesterday, castMD must speak out again.

The Emergency Departments are at a break point. A year or so ago, almost 3/4 of all medical directors said their ER has inadequate specialist on-call backup! There are fewer specialists in general surgery being trained, and neurosurgeons are at a standstill in training numbers. Many of the ortho, neuro, and plastic surgeons are older and not being replaced in numbers.

Yet the numbers of ER patients is exploding in numbers. Many patients are uninsured, underinsured, and have serious illnesses and injuries. ERs must see, triage, treat, and plan for each one without asking for a dime upfront. Declining reimbursement with increasing costs is a martial arts contest in the ERs. EMTALA dictates ERs must see everyone! The on-call specialist to the emergency doctors have high liability with these patients. Some specialty groups have stated one third of their groups have been sued by patients that they have responded to in the ER patient's time of greatest need.

Many ERs have closed, and more will. Many hospitals cannot continue to absorb the see all and sue all patients under the mandated-free care system. It is broken, and yesterdays marches reminded me. No one should be turned away in a critical time of health-need, but the system is critical now.

Washington State did not pass tort reform. Why work there? Why be on call to an ER that will lead the doctor to critical patients with high malpractice risk? You wonder why doctors quit being "on-call" to trial attorneys. Oh, did the drycleaners mistake settle for the 60+ million yet?

DRUG ERROR – COLCHICINE – POSSIBLY LINKED TO FATALITIES

Monday, April 30th, 2007
THIS IS IMPORTANT INFORMATION FOR THOSE PERSONS SEEKING MEDICAL AIDES AND MEDICAL CURES.  (REFERENCE CITED.)  
 
 
 
 
(generic photos from tufts.edu and generic medicines)
 
 
HeraldNet
The Herald – Everett, Wash. – www.HeraldNet.com

Published: Saturday, April 28, 2007

Toxic drug at Portland clinic causes three deaths

Associated Press

 


PORTLAND, Ore. – Three people in the Pacific Northwest have died after receiving a drug that was erroneously made 10 times more potent than intended, the Oregon State Medical Examiner’s Office said Friday.

ApotheCure Inc., a drug-compounding pharmacy company in Texas, said an employee made a weighing error in the creation of the drug colchicine, which lead to the deaths. Colchicine is commonly used to treat gout, but in these cases it was being given intravenously to treat back pain.

The drug was sent to the Center for Integrative Medicine in Portland, where three people received injections of the defective batch of the drug this spring. All three people, two from Portland and one from Yakima, died between the end of March and beginning of April from the toxic levels of the drug.

The defective doses were sent only to the Portland clinic, ApotheCure said.

The Food and Drug Administration said it is investigating the case but believes the problem has been contained.

The Center for Integrative Medicine has since closed, and representatives from the organization could not be reached.

Colchicine works by stopping cells from dividing, which reduces inflammation in conditions such as gout, said Dr. Rob Hendrickson, associate medical director for the Oregon Poison Center. But in excess doses, the drug stops all cells from dividing – eventually leading to organ failure and death.

The medication is not commonly used anymore and the use as a back pain treatment is less common than for gout.

Gary Osborn, a pharmacist and certified clinical nutritionist for ApotheCure, said the situation could have been contained earlier, but the clinic did not contact ApotheCure until nearly two weeks after the first death. He said the second death occurred before the company was able to complete recalling the batch and sending them a new lot. He said this is ApotheCure’s first incident of this sort.

“We are kind of the leaders in the industry,” Osborn said. “But you know what people say, stuff happens.

 

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