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Purdue Pharma, maker of OxyContin and lesser known MS Contin, is facing scrutiny after several recent articles exposed information from a Justice Department investigation into the company. The investigation focused on evidence that showed Purdue’s legal council and executives were aware of the addictive nature of their drugs, including their popularity with drug seekers. Despite knowing their drugs were being misused, the company continued a false marketing campaign that promoted the drug as safer than other opioids because it was less likely to be abused or cause addiction. The company still maintains that they weren’t aware of users abusing their drugs until Maine’s attorney general issued an alert about the drug in 2000, despite federal investigators finding proof that company salespeople were aware as early as 1997, just a year after the release of OxyContin.

The federal investigation ended in 2007 with Purdue Pharma pleading guilty to a felony charge of deceptive advertising and 3 top executives pleading guilty to misdemeanor charges. The company paid $635 million in fines to the government, while the execs did community service and avoided jail time. According to many familiar with the case, Purdue’s executives were given a proverbial hall pass, missing a potentially huge opportunity to throw a roadblock in the now public health crisis that is America’s opioid crisis. Many have called drug company executives behind opioids at the center of the crisis “suited drug pushers,” no better than street drug dealers. Others have said that if they were a minority in street clothes selling these drugs, they’d be locked up. Instead, drug company executives who knowingly market these drugs and force their sales reps to push them on doctors with false claims of safety and less addictive formulations are skating by, continuing to receive large bonuses and stock options while fueling the ongoing drug crisis.

Internal Emails Reveal Awareness of OxyContin’s Street Reputation

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In fall 2015, stories began circulating that a study had shown that chemo wasn’t already required as part of breast cancer treatment. But after awhile, the conversation started to dwindle. That is until now. Today in Chicago, attendees of the annual meeting of the American Society of Clinical Oncology are hearing study findings that chemotherapy may no longer be required for all women diagnosed with breast cancer. The study, called TAILORx, was a team effort by the U.S. and Canadian governments, as well as several charitable organizations.

Chemo Found to Have No Impact on Early-Stage Breast Cancer Survival Rates

TAILORx began in 2006 and followed 6,800 women from age 18-75 who had received an early stage breast cancer diagnosis, defined as tumors that have not spread to the lymph nodes and range between 1-5 cm. The women must also have tested negative for HER2, a protein found to be a major contributor to breast cancer.

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The health insurance giant’s ‘avoidable E.R.’ policy has their insured customers playing doctor and deciding between the emergency room or toughing it out at home or at urgent care.

Anthem, the second largest health insurance provider in the country, is under fire from doctors, hospital groups, health policy experts, politicians, and especially its customers for a new policy that aims to cut back on E.R. visits. The policy is now in effect for Anthem customers in Connecticut, Georgia, Indiana, Kentucky, Missouri, Ohio and New Hampshire. According to an Anthem spokesperson, the idea behind the policy is to help keep healthcare costs down for everyone. The company says that 5% of all E.R. visits are unnecessary and that (unneeded) emergency care costs 10 times more in an E.R. than it does in an urgent care or retail healthcare setting.

E.R. Flu Visits Not Covered Under Policy

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The American College of Obstetricians and Gynecologists (ACOG) just released guidelines advising all OBs in this country to change the way they care for mothers in the 3 month period following childbirth. Instead of the traditional 6 week postpartum visit, the new guidelines recommend seeing all mothers no more than 3 weeks following childbirth, or within 3 days if the mother had severe hypertension during pregnancy, childbirth or immediately following. ACOG also recommends a 12 week final visit that assesses the mother’s overall health and well-being, with attention focused on future family planning, sexual issues, and emotional stability. ACOG’s guidelines also urge OBs to discuss the long term risks associated with certain conditions suffered during pregnancy, such as preeclampsia and gestational diabetes. After leaving the hospital, many mothers feel as though their health and needs are essentially forgotten. We know now that overlooking a woman who has just given birth can have tragic consequences.

More Mothers Die in America Than Other Developed Countries

A 6 month long NPR/ProPublica investigation last year found that the maternal death rate in the U.S. is higher than in any other developed country and that it is on the rise. Black mothers fare the worst.  A black mother is 3 to 4 times more likely to die during pregnancy, childbirth, or during the postpartum period than a white mother. Our blog has previously touched on the reasons why: black women have higher rates of heart disease and other health conditions that impact pregnancy, and they are subjected to more stress than white women.

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The University of Illinois at Chicago and Dr. Nagamani ‘Mani’ Pavuluri, widely considered an expert on bipolar disorder in children, have both been accused of violating medical ethics during a clinical study that studied the affects of lithium on children suffering from bipolar disorder. This past November, Dr. Pavuluri and UIC were ordered to repay all $3.1 million granted to them by the National Institute of Mental Health (NIMH), something many experts say is unprecedented.

Doctor Violated Protocol  

Dr. Pavuluri’s study took place between 2009-2013 and involved 103 children, some as young as 10 years old. The aim was to examine how a young brain functioned during a manic phase of bipolar disorder, then compare it to the brain after an 8 week course of lithium. After an initial review of Dr. Pavuluri’s grant application for the study, she was told by NIMH to correct several things before they would approve her for a grant. Dr. Pavuluri amended her application to correct the below listed flaws and was approved for $3.1 million in funding to conduct her research. However, she was found to have violated each of the things she specifically agreed to change in order to receive funding.

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A study of 440 emergency department doctors found that examinations are less thorough when ERs are so crowded that patients are treated in the hallway. Conducted at a 2015 Boston medical conference, the study revealed that 75% of physicians surveyed copped to obtaining less thorough medical histories of patients under these circumstances. Of that 75%, nearly all admitted that they also changed their standard procedure for conducting a physical exam.

Women who presented with genital or urinary problems were found to be the most underserved group, with the majority of doctors admitting that these issues impacted the way they conducted a physical exam or took a patient’s medical history. Interestingly, the majority of physicians surveyed also said that even in a private room, the presence of someone else known to the patient impacted the questions they asked and the way in which they went about an exam.

The issue of privacy is multilayered. In addition to the majority of doctors being surveyed acknowledging that the presence of others affects their practice of medicine, patients also are believed to withhold information when spouses, family members, friends, and strangers are present.

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It seems unbelievable, but it’s true: Last year, the Illinois Department of Financial & Professional Regulation (IDFPR) did not conduct a single National Practitioner Database (NPDB) background check on any physician applying for a license in the state. Information obtained from the NPDB is considered a fundamental part of the review process in granting a physician a license. The federally-sponsored database includes information on infractions, including citations for improper conduct by state medical boards and hospitals. Information regarding malpractice lawsuits are also included. By federal law, these groups must submit physician data to the NPDB, something other databases containing physician information cannot claim.

It’s Always About Money

According to a Chicago Tribune investigation, half of penalties handed out by the IDFPR in 2012 were for actions another state’s medical board had already disciplined them for. 100 physicians were disciplined based on another state’s information. That same year, less than 30 doctors were penalized after being cited for failure to diagnose a patient or committing some other form of medical error or oversight within Illinois. According to experts, the reason is due to costs. It is easier to go after a physician when another state has already done the leg work and the IDFPR simply does not have the time, nor resources to do a thorough investigation.

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Each year, an estimated 795,000 people have a stroke. Strokes are classified as either ischemic or hemorrhagic, with ischemic strokes afflicting 87% of those who suffer. Clots in vessels that lead to the brain cause an ischemic stroke and evidence has shown that quick recognition and treatment of this type of stroke is the most critical element in predicting long term outcomes. Since 1996, the FDA “gold standard” treatment for an ischemic stroke is tPA, or tissue plasminogen activator. This drug, given by IV within 3 (or sometimes 4.5) hours of the stroke’s onset, opens blocked blood vessels by dissolving the clot. Rapid treatment with tPA can prevent brain cell death caused by lack of blood flow to the brain. In other words, the drug has been shown to substantially decrease the neurological aftermath of a stroke. Both the American Heart Association and the American Stroke Association call for the use of tPA in patients who don’t have contraindications. Yet, almost 30% of all ischemic stroke patients are not given this drug.

Side Effects in Some Tainting Benefits for Others

tPA is certainly not for every stroke patient. The drug is only meant to be used in patients who arrived at the hospital within 3 hours of the onset of an ischemic stroke and have been cleared by a trained physician.

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There are just over 5,600 federally accredited, Medicare-approved, surgical centers in the United States. Considered a more affordable, less-hassle option than having surgery performed within a hospital, patients should be aware of the risks involved, including the inability of their medical team to save their life in case of an emergency.

Without a federal database that tracks the number of adverse events or number of deaths during or immediately following procedures at these facilities, little is known about the outcome of surgeries performed there. In years past, the only negative chatter surrounding surgical centers seemed to be news stories of botched procedures performed at plastic surgery centers by unskilled medical professionals or those masquerading as one. It wasn’t until 2014 and the death of Joan Rivers at a New York City surgical facility that many realized these facilities were often ill-equipped to handle medical emergencies, despite numerous doctors and surgeons being on site. This month, a joint Kaiser Health News (KHN) & USA Today investigation revealed that at least 260 people have died since 2013 after having a routine procedure performed at a surgical center in the United States.

Joan Rivers Case Highlights Surgical Center Flaws

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A February 16th article in Crain’s Chicago Business covered the increase in opioid-related overdoses and their impact upon hospitals in Illinois. The number of overdoses is rising, but so are the costs associated with treating these patients. Between January-September 2016, the number of opioid-related emergency room visits was 77% higher than that same time period just a year before. Nationwide, the average cost of an intensive care unit stay for an overdose was $58,517 in 2009. In 2015, the average cost per ICU stay jumped to $92,408.

A representative for Cook County Health and Hospital System told Crain’s that they estimate they spent $25 million last year treating between 4-5,000 patients with opioid-related illnesses. As a point of comparison, they treated 1,000 of these patients in 2006.

Loretto Hospital says that 1 out of every 3 patients in the emergency room is there to be treated for an opioid-related issue. They also estimate that nearly 40% of the patients admitted for treatment are later readmitted, something that costs them more than just writing off a single visit. Readmission rates have been a major quality indicator for hospitals and under the Center for Medicare and Medicaid Services “Readmissions Reduction Program,” hospitals who have high readmittance rates will see reduced payments from Medicare and Medicaid. For many hospitals, Medicaid reimbursements make up a large chunk of their revenue.