Friday, December 19, 2014

Should you always trust an Ivy-Leage doctor? Will they sometimes lie to you for financial gain?

There's more than one way for doctors to make profits by concealing facts from patients.   Not all the products they promote are sold through the media, as seen in the story of Dr. William Taylor at UCSD.

Real-world doctors fact-check Dr. Oz, and the results aren't pretty
Only one-third of claims made on 'The Dr. Oz Show' can be backed by medical evidence, study says
11% of the recommendations made by Dr. Oz or his guests contradict medical facts, researchers say
Viewers of 'The Dr. Oz Show' should be skeptical about advice given on the program, experts conclude
What do real-world doctors have to say about the advice dispensed on “The Dr. Oz Show”? Less than one-third of it can be backed up by even modest medical evidence.
If that sounds alarming, consider this: Nearly 4 in 10 of the assertions made on the hit show appear to be made on the basis of no evidence at all.
The researchers who took it upon themselves to fact-check Dr. Oz and his on-air guests were able to find legitimate studies related to another 11% of the recommendations made on the show. However, in these cases, the recommendations ran counter to the medical literature.

“Consumers should be skeptical about any recommendations provided on television medical talk shows,” the researchers wrote in a study published this week in BMJ. “Viewers need to realize that the recommendations may not be supported by higher evidence or presented with enough balanced information to adequately inform decision making.”

Critics of Dr. Mehmet Oz, an accomplished cardiac surgeon with degrees from two Ivy League universities, complain that his show is little more than an hour-long infomercial for weight-loss fads like green coffee bean extract. (The Federal Trade Commission has sued the company that hawks this dubious product.) A spokesman for the Center for Inquiry accused him of selling “snake oil.” In June, a Senate subcommittee took him to task for telling his viewers (who number 2.9 million on any given day) things like: “I’ve got the No. 1 miracle in a bottle to burn your fat. It’s raspberry ketones.”

“I don’t get why you need to say this stuff because you know it’s not true," Sen. Claire McCaskill (D-Mo.) said during the hearing...

Wednesday, November 19, 2014

Deep sedation for colonoscopy might not be safe
Consumer Reports
Nov. 19, 2014

Getting knocked out during a colonoscopy might seem like a good idea. After all, being awake as your doctor uses a long, flexible tube to get an inside view of your lower intestines doesn't sound very appealing. To avoid that problem, many doctors now routinely use the drug propofol (Diprivan) during colonoscopy to cause deep sedation in their patients.
But beware: That drug, which was reportedly given to Joan Rivers  soon before she died, might not be the healthiest choice and could put you at risk for some serious complications.
Don’t get the wrong idea: Colonoscopies are usually safe (about 3 out of every 1,000 people suffer a serious complication). And the procedure is proved to prevent colon cancer deaths. So if you’re ages 50 to 75, you should be screened (see our guide, "The Cancer Tests You Really Need," to find out how often you should be screened). 
But deep sedation isn't necessary. Colonoscopy can be done using conscious sedation or even none at all. “You should always try to aim for the lightest level of sedation that you need,” says Consumer Reports' medical adviser, Orly Avitzur, M.D. “The trend toward deep sedation is worrisome because it increases risk.”
For example, propofol increases your risk of aspiration pneumonia (caused by inhaling particles such as vomit, mucus, or saliva) by almost 50 percent, according to a study by Gregory Cooper, M.D., in the journal JAMA Internal Medicine. And it can cause a host of other side effects, including confusion, seizures, irregular heart beats, and potentially deadly allergic reactions.  
“For the general population there’s not a lot of good data saying patients have a better outcome with propofol when there’s not a medical indication,” says Cooper, a professor of medicine at Case Western Reserve University in Cleveland. “It’s overkill.”
Instead, Cooper says he uses the narcotics fentanyl (Duragesic and others) or meperidine (Demerol) combined with midazolam (Versed) to induce light sedation during colonoscopies.  
And propofol is expensive. Colonoscopies using anesthesia cost about 20 percent more than those done without, according to Cooper. And a 2013 research letter in JAMA Internal Medicine titled, "Propofol for screening colonoscopy: Are we paying too much?" said that the use of propofol typically added $600 to $2,000 to the price tag.
Screening colonoscopies are covered by insurance plans, thanks to the Affordable Care Act, although you might have to pay for part of the anesthesiologist’s fees, bowel prep kit, pathology costs, and a facility fee. But even so, “Somebody’s got to pay for it, whether it’s the insurance company or the patients,” Cooper says, adding that the current system provides a financial motivation for using more anesthesia.
But the rising tide of propofol use could be about to ebb. Beginning Jan. 1, 2015, Medicare is changing how it pays anesthesia professionals for colonoscopy care. Gastroenterologists will be paid a set amount that will cover the anesthesia cost, even if an anesthesiologist, for example, administers it. Doctors will then have to decide whether to recommend expensive anesthesia, which could include hiring a nurse anesthetist or anesthesiologist and pay them out of the same pot, or choose a less pricey option. “There may be a financial disincentive for Medicare doctors to recommend deep sedation,” Avitzur says.
We’ll have to wait to find out if commercial insurers follow Medicare’s lead. If they do, says Cooper, “There will be less cost to the health care system since there won’t be another bill from the anesthesiologist.”
Until then, if you’re gearing up to have a colonoscopy, make sure you discuss your anesthesia options with your doctor before the procedure.

Tuesday, November 11, 2014

L.A. County Health Dept. Allegedly Falsified Nursing Home Records of Complaints

L.A. County Health Department Allegedly Falsified Nursing Home Probe Records

The Los Angeles County Public Health Department falsified the dates it received complaints about nursing homes as pressure rose to meet state deadlines for launching investigations, according to two employees.
In a letter last month to county, state and federal officials,  inspector Kimberly Nguyen cited 11 cases in which she said the dates typed into the computer system were later than the dates the complaints were actually received. The cases mentioned in the letter involve alleged abuse, falls and pressure sores, she said.
“In my belief, falsification is a serious matter and unlawful and our department should know better to not manipulate paperwork to mislead others and the public,” Nguyen wrote in the Oct. 7 letter.

...Meanwhile, the state, which directly oversees nursing homes in every district except Los Angeles County, has had its own history of problems with timely investigations. A lawsuit by California Advocates for Nursing Home Reform, or CANHR, resulted in a 2006 order by a Superior Court judge instructing public health officials to follow the law regarding investigation timelines.
Geraneo noted that order in her e-mail to administrators, referring to a case involving a non-working generator in which the complaint year had allegedly been changed from 2013 to 2014. “We cannot change the initiation dates of these complaints because of the CANHR lawsuit!”
Geraneo declined to be interviewed.
Since Kaiser Health News began writing about the department’s health facilities inspection division in March, administrators have sent e-mails to staff telling them not to speak to the media and to forward all requests. Reached by phone, several inspectors have declined to talk, saying they feared retaliation.
Nguyen said  she has been she has been targeted for retaliation as a result of raising questions since July 2013 about the quality of nursing home oversight.
In May 2014, Nguyen was suspended for five days without pay because she allegedly failed to renew her nursing license. A department letter said her license expired on November 30, 2013 and that she worked for six days without a valid license.
But as the Board of Nursing later confirmed in writing, her license actually had been renewed promptly. The Board simply hadn’t entered the renewal on its website.




L.A. County Health Dept. Allegedly Falsified Nursing Home Records

Two Los Angeles County Public Health Department employees allege that the department falsified the dates it received nursing home complaints in order to meet state deadlines for launching investigations, Kaiser Health News reports.


Under state law, investigations must be launched within 10 days of receiving a nursing home complaint -- or within 24 hours if the complaint involves the threat of death or serious harm.
The California Public Health Department requires inspectors to enter dates based on when the complaint was first received by phone, fax, email or letter.

Details of Falsified Records

In a letter sent last month to county, state and federal officials, Inspector Kimberly Nguyen cited 11 cases in which she found records with falsified dates.
The dates entered were much later -- as much as 79 days --than the dates the allegations actually had been submitted.
The cases involved complaints about:
  • Abuse;
  • Falls; and
  • Pressure sores.
According to KHN, Nguyen said she believes the date manipulation was deliberate (Gorman, Kaiser Health News, 11/10).
Nguyen said her supervisor, Adewole Adegoke, has been aware of the record falsification since July but has made no effort to stop the practice (Nguyen Letter, 10/7). She wrote, "In my belief, falsification is a serious matter and unlawful, and our department should know better to not manipulate paperwork to mislead others and the public."
Meanwhile, Sharon Geraneo, an assistant supervisor at the department, sent a separate email in August about the department allegedly falsifying records.

Response to Allegations

The county Department of Public Health said it has "zero tolerance for intentional document falsification" and is not aware of any deliberate falsification.
Officials said that they had identified a data entry error by one individual that affected 35 cases but that "swift and appropriate corrective actions" were taken.
The California Department of Public Health said it is investigating the allegations (Kaiser Health News, 11/10).

Sunday, November 9, 2014

Power morcellation ban unlikely, but other FDA restrictions coming soon

Power morcellation ban unlikely, but other FDA restrictions coming soon
The doc spearheading the antimorcellation campaign says FDA is divided, as are gynecologists

Johnson & Johnson's Ethicon division's power morcellation device, which has been recalled since the controversy errupted--Courtesy of Johnson & Johnson
The doctor who brought the cancer risks posed by power morcellation to the attention of the public and the FDA protested what he described as "imminent plans to use legal mechanisms to functionally institute a 'registry of outcomes' or a 'probationary period' in order to avoid banning power morcellators from the marketplace," in an email to Commissioner Hamburg, various U.S. senators, White House officials and others obtained by FierceMedicalDevices.
Cardiac surgeon Hooman Noorchashm and wife, Amy Reed, an anesthesiologist, have led the charge against the controversial surgical technique performed using the drill-like power morcellator. Power morcellation can upstage preexisting uterine cancers like uterine sarcoma to fatal levels.
Noorchashm and Reed have sparked public outcry, an FDA safety notice and a recall of power morcellators by former market leader Johnson & Johnson ($JNJ) via efforts like a petition on Now they are aiming to take the campaign to its logical conclusion by securing an FDA ban of the device. That does not appear likely, according to information Noorchashm has received from a source within the FDA, who he wouldn't name during an interview.

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Sign up for our FREE newsletter for more news like this sent to your inbox! Noorchashm described a power struggle within the FDA in the interview, saying, "My impression is that inside the FDA there are two groups of individuals: individuals who are more interested in advocating for industry interests and individuals who understand that the position of the FDA should be to protect patient safety and ensure patient safety. Those two groups of people are basically struggling."
The FDA's Office of Policy and Planning favors stricter action, but the agency's device arm, the Center for Devices and Radiological Health (CDRH) is spearheading a plan to put the device on probation instead, he said.
"The imminent plan that the CDRH has is to sugarcoat this thing using a probationary mechanism. That would deflect any sort of criticism away from 510(k). It would deflect public criticism of anyone who says FDA didn't do anything. CDRH can comes out and says, 'Well we did something. We put out an FDA advisory and we put the device under probation.' That basically will give industry a chance to recover from an absolute medical atrocity," he said.
It is unclear what a probation would entail. During the FDA's public hearing on power morcellation, the agency discussed solutions such as enhanced informed consent requirements, the use of a surgical bag during morcellation and the need for improved testing of uterine sarcoma prior to surgery. A ban of power morcellators was also on the table, although agency officials didn't seem too intent on that option.
Central to the debate is the prevalence ratio of uterine sarcoma prior to power morcellation. The FDA estimates that the ratio is one women in 350.
A well-publicized paper in the Journal of the American Medical Association estimated that the rate of uterine cancer in women who underwent morcellation was one in 370. However, uterine sarcoma is a rare subset of uterine cancer that is more difficult to detect prior to surgery than other cancers of the uterus. Uterine sarcoma specifically is the main cause of concern among the FDA and other public health experts.
The paper's author, Dr. Jason Wright of the Columbia University College of Physicians and Surgeons, said in an email to FierceMedicalDevices that he is unable to separate sarcomas or other subtypes of uterine cancer based on the insurance database. But he added, "I would assume that most cancers (in the sample) were not known preoperatively in women who underwent morcellation."
"Physicians who are defending this are saying the incidence (of uterine sarcoma in women undergoing morcellation) is one in 7,500," Noorchashm said, referring to research by obstetrician-gynecologist Elizabeth Pritts of the Wisconsin Fertility Institute.
Pritts spoke at the FDA public hearing and believes the agency is wildly overestimating the prevalence of uterine sarcoma because the agency used confirmation bias in its literature review used to arrive at its estimate of one in 350 women.
To add to the complexity, most experts assume that power morcellation poses a great chance of upstaging preexisting uterine sarcoma to fatal levels because it shreds and spreads the cancerous tissue to new parts of the body. However, in October Pritts and medical colleagues published a paper in the Journal of Minimally Invasive Gynecology concluding "there is no reliable evidence that morcellation (power or otherwise) significantly results in tumor upstaging."
"The new data by Dr. Pritts et al reveal that there is no proof that uterine morcellation upstages cancer. This is a critical discovery and changes the framework for discussion of how to care for the 31 million women with symptomatic fibroids," said gynecologic surgeon Antonio Pizarro in Shreveport, LA in an email. "Dr. Wright has issued a report of lapses in preoperative diagnosis for women with detectable cancers, not a report on sarcoma on women with fibroids."
Other members of the field favor strict action against power morcellators. "What you do about it is: you stop," said Robert Graebe, chairman and program director of the Department of Obstetrics and Gynecology at NJ-based Monmouth Medical Center in a prior article in The Wall Street Journal, adding "it's not worth playing Russian roulette with the patient."
So far the FDA has only banned one device. In 1983 it outlawed prosthetic hair fibers.
"The FDA is considering a great deal of information, including the panel's input, all comments from the public docket, and all relevant available data, in determining any future regulatory action. If the FDA decides to take further action, we will issue communication to inform manufacturers and the public, including notice in the Federal Register," said an FDA spokeswoman in an email to FierceMedicalDevices.
Meanwhile, the Democrat & Chronicle reports that a third Rochester, NY, woman has recently died of an undetected cancer two years after undergoing power morcellation.
- here is the email
- here's the article in the Democrat & Chronicle
- here's Dr. Pritt's paper abstract
Related Articles:
Physicians defend power morcellator devices amid industry fallout
Johnson & Johnson pulls power morcellator devices amid industry and regulatory backlash
Upcoming study to dispute FDA's data on power morcellation risk
FDA panel recommends stronger labeling, limiting use of power morcellation--agency may go further
Power morcellator fallout continues after FDA advisory warning

Sunday, November 2, 2014

Drinking a lot of milk doubled the risk of death for women, and increased hip fractures by 60%

Milk causes osteoporosis? How many trillions to we pay for medical care in the US? Why did we need to wait for a tiny country like Sweden to give us this information?

For years doctors prescribed large doses of Vitamin D and calcium that turned out to be no help at all with osteoporosis. All that time, our doctors never warned us against milk.

And the medical establishment moans about its helplessness in the face of Alzheimer's, but forgot to mention that D-galactose was associated with memory loss in animals in research going back to 2006. Certainly, my doctors never mentioned it.

Is our health being held hostage to the profits of politically-powerful groups like the milk lobby? It seems like every month I am presented with a new reason for not trusting the CDC (Center for Disease Control). It seems that the research done by the government too often involves increasing or protecting profits for some powerful, wealthy group of people. New drugs, new devices, new procedures keep coming down the pipeline. But of course, the people who repair broken hips aren't going to make as much money now that women have this information from Sweden.

Drinking a lot of milk may be shortening women’s lives
October 30, 2014
By Karen O’Shea
Irish Examiner

Drinking three or more glasses of milk per day may be harmful to women’s health, a study suggests.
Women in the study who drank at least three glasses of milk a day were nearly twice as likely to die over the next 20 years compared with their peers who drank less than a glass daily, researchers in Sweden found. In addition, the study, published in the British Medical Journal found that women’s risk of bone fracture climbed steadily as their milk intake increased.

The reason could be galactose, a simple sugar found in milk, said Karl Michaelsson, a professor at Uppsala University in Sweden and one of the study’s authors. “That compound might induce oxidative stress and low-grade inflammation, and that type of inflammation can affect mortality and fractures,” Michaelsson said. 

Many health bodies recommend that adults get the equivalent of three cups of milk daily, based on the idea that dairy is good for the bones, and may reduce heart disease risk. But there’s actually little scientific evidence to support these recommendations, the study authors said.

The study included 61,433 women who were ages 39 to 74 at the study’s start, and 45,339 men ages 45 to 79. The women were followed for 20 years, on average. During that time, 15,541 died and 17,252 had fractures, including 4,259 hip fractures. After the researchers took into account factors like age, body mass index and alcohol consumption, they found that women who drank three or more glasses of milk daily were 1.93 times more likely to die during the follow-up period than those who drank less than a glass of milk daily. 

Among the men, who were followed for an average of 11 years, there was no association between mortality or fractures and milk consumption. 

But dairy lovers need not despair. The researchers found that fermented milk products, like cheese and yogurt, which contain little or no galactose, had the opposite effect: women who ate or drank the most fermented milk products were less likely to die or sustain fractures during the study.

Milk intake and risk of mortality and fractures in women and men: cohort studies

  • Accepted 22 September 2014


Objective To examine whether high milk consumption is associated with mortality and fractures in women and men.
Design Cohort studies.
Setting Three counties in central Sweden.
Participants Two large Swedish cohorts, one with 61 433 women (39-74 years at baseline 1987-90) and one with 45 339 men (45-79 years at baseline 1997), were administered food frequency questionnaires. The women responded to a second food frequency questionnaire in 1997.
Main outcome measure Multivariable survival models were applied to determine the association between milk consumption and time to mortality or fracture.
Results During a mean follow-up of 20.1 years, 15 541 women died and 17 252 had a fracture, of whom 4259 had a hip fracture. In the male cohort with a mean follow-up of 11.2 years, 10 112 men died and 5066 had a fracture, with 1166 hip fracture cases. In women the adjusted mortality hazard ratio for three or more glasses of milk a day compared with less than one glass a day was 1.93 (95% confidence interval 1.80 to 2.06). For every glass of milk, the adjusted hazard ratio of all cause mortality was 1.15 (1.13 to 1.17) in women and 1.03 (1.01 to 1.04) in men. For every glass of milk in women no reduction was observed in fracture risk with higher milk consumption for any fracture (1.02, 1.00 to 1.04) or for hip fracture (1.09, 1.05 to 1.13). The corresponding adjusted hazard ratios in men were 1.01 (0.99 to 1.03) and 1.03 (0.99 to 1.07). In subsamples of two additional cohorts, one in males and one in females, a positive association was seen between milk intake and both urine 8-iso-PGF2α (a biomarker of oxidative stress) and serum interleukin 6 (a main inflammatory biomarker).

Conclusions High milk intake was associated with higher mortality in one cohort of women and in another cohort of men, and with higher fracture incidence in women. Given the observational study designs with the inherent possibility of residual confounding and reverse causation phenomena, a cautious interpretation of the results is recommended.


A diet rich in milk products is promoted to reduce the likelihood of osteoporotic fractures. Milk contains 18 of 22 essential nutrients, including calcium, phosphorus, and vitamin D of especial importance for the skeleton. Intestinal uptake of these nutrients is enhanced by the enzymatic capacity to digest lactose into D-glucose and D-galactose by mutation in the lactase gene, a variant common in those with northern European ancestry.1 2 An intake of dairy foods corresponding to three or four glasses of milk a day has been suggested to save at least 20% of healthcare costs related to osteoporosis.3

A high intake of milk might, however, have undesirable effects, because milk is the main dietary source of D-galactose. 

Experimental evidence in several animal species indicates that chronic exposure to D-galactose is deleterious to health and the addition of D-galactose by injections or in the diet is an established animal model of aging.4 5 6 7 Even a low dose of D-galactose induces changes that resemble natural aging in animals, including shortened life span caused by oxidative stress damage, chronic inflammation, neurodegeneration, decreased immune response, and gene transcriptional changes.5 7 A subcutaneous dose of 100 mg/kg D-galactose accelerates senescence in mice.5 This is equivalent to 6-10 g in humans, corresponding to 1-2 glasses of milk. Based on a concentration of lactose in cow’s milk of approximately 5%, one glass of milk comprises about 5 g of D-galactose. The increase of oxidative stress with aging and chronic low grade inflammation is not only a pathogenetic mechanism of cardiovascular disease and cancer in humans8 9 but also a mechanism of age related bone loss and sarcopenia.9 10 The high amount of lactose and therefore D-galactose in milk with theoretical influences on processes such as oxidative stress and inflammation makes the recommendations to increase milk intake for prevention of fractures a conceivable contradiction.

  1. Karl Michaëlsson, professor1,
  2. Alicja Wolk, professor2,
  3. Sophie Langenskiöld, senior lecturer3,
  4. Samar Basu, professor3,
  5. Eva Warensjö Lemming, researcher14,
  6. Håkan Melhus, professor5,
  7. Liisa Byberg, associate professor1
    Author affiliations
  1. Correspondence to: K Michaëlsson

Tuesday, October 28, 2014

The medical establishment values profits over patient lives, as seen in Morcellation procrastination

Husband grieves over "unnecessary" death

After George Leuzzi pays final respects to his wife on Tuesday at her funeral, he will turn his attention to caring for their young daughter and bringing an end to a procedure that claimed 44-year-old Brenda.
"Now that she's passed I will do my part to carry on what she started," he said. "I will help as much as I can to get this removed."
Brenda Leuzzi died 25 months after fibroid surgery through minimally invasive procedure that involved power morcellation. At the time, no one knew the fibroids, thought to be innocent growths, were cancerous. There is no definitive pre-surgery test to determine whether fibroids are benign. Power morcellation shreds tissue so that it can be removed through small incisions of minimally invasive surgery. In so doing, it can send bits of cancer to other parts of the abdomen, where they can "seed."
A grassroots effort to end power morcellation has been going on for just about a year, since the problem was brought to light by a physician whose wife had an undetected cancer worsened by the procedure.
The Food and Drug Administration has issued advisories against the procedure and the leading manufacturer, Johnson & Johnson, has asked providers to return the devices. But other manufacturers have them on the market. The FDA held hearings in July about the safety of the procedure.
The same day that George Leuzzi buried his wife, Morgan Liscinsky of the FDA press office answered a request for an update with, "I have no new information to share since you contacted me last month."
Sens. Chuck Schumer and Kirsten Gillibrand wrote in August to FDA Commissioner Margaret Hamburg. That letter was on behalf of Jim Leary of Greece, whose wife, Barbara, died last year after having undergone a procedure that involved morcellation.
Asked what the senators are doing to step up pressure, Gillibrand spokesman Jacob Fromer responded: "It is deeply frustrating to the Senator that while the FDA discourages the use of these very devices they won't take the necessary action to ban them. She will continue to communicate her concerns to the commissioner. Kirsten's thoughts and prayers are with the Leuzzi family, particularly their young daughter, Peyton."
Schumer spokesman Max Dworin said the office "followed up with the FDA (Monday), urging them again to call on manufacturers to voluntarily recall these devices, and we will continue to push."
Schumer's statement Monday read, ""The passing of Brenda Leuzzi is tragic and further underscores the urgency for all firms to voluntarily recall these devices until more thorough testing can be done. The FDA should act before another family has to experience what the Leuzzi family is going through right now. My thoughts and prayers go out to the entire Leuzzi family."
George Leuzzi is more adamant than Schumer. "I'm very disappointed in the FDA. They should have banned this by now. They're just stalling and finding some other way to convince themselves it's OK. If anybody saw Brenda and the way she died, it's pretty far from OK. I wouldn't wish it on my worst enemy."
George Leuzzi said he's received an uncountable number of texts and emails since he posted on a leiomyosarcoma Facebook page news of Brenda's death.
"Cancer is the enemy, but any procedure that would enhance it and make it worse and put someone in a position to have no way of rebounding from it is criminal," he said.
As it was during Brenda's illness, her husband's focus is on his wife.
"I want her to be remembered. I don't want her to be forgotten, especially because what she died for was completely unnecessary."

Sunday, October 12, 2014

Are California doctors violating their Hippocratic oaths in California Prop 45 fight?

  Physician, Executive Chairman of the Courage Campaign, Healthcare Activist
Huffington Post 
An Open Letter to my fellow medical professionals about California's Proposition 45 and the primary obligation we have to protect the well being of our patients.

Like generations of doctors before us, when each of us graduated from medical school, we were asked to raise our hand and recite the Hippocratic Oath. This was a defining moment in many of our lives. Reciting the words carried great weight and purpose: "I will apply all measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice."

It is through the prism of these words that I watch you appearing in advertisements against Proposition 45 and react in horror. Dr. Amy Nguyen Howell, Dr. Marshall Morgan, and Dr. John Maa, I believe you are betraying your Hippocratic Oaths, and Registered Nurse Candace Campbell, I believe you are betraying the Nightingale Pledge. In fact, in your roles advocating against Prop 45, you are spreading lies designed to mislead and scare the public -- our patients -- in order to protect the insurance industry. It is unconscionable.
The facts are that since 2002, health insurance premiums have increased 185%, while wages for the bottom 70% of our state have remained stagnant. During this same time, California health insurers have issued over 45.7 million denials of treatment, while making record profits which have translated into record cash reserves in the billions.

So let's take a real look at your arguments:

In advertisements paid for by the health insurance industry, you claim that we should keep the new "independent commission" and that special interests are sponsoring Proposition 45 to give "one politician" new power over our health care -- including what treatment options our health insurance covers.
First off, there is absolutely no conflict between this new "independent commission" -- Covered California -- and Prop 45. The Affordable Care Act (Obamacare) was written to accommodate just this sort of rate regulation, and 35 other states already have some version of it.

Covered California is actually run by purely political appointees, some of who have a long cozy history with the private insurance industry. Unlike the State Insurance Commissioner, who is publicly elected to serve as the ultimate consumer protector, the citizens of California have no say in who is appointed to this "independent commission" whereas the Insurance Commissioner is publicly accountable and can be voted out of office.

As for giving the Insurance Commissioner new power over treatment options, this is false on so many levels. First and foremost, it is the private health insurance industry and their administrators, many of who have never cared for a patient, who are denying care, while telling doctors what treatment and drugs they can provide. Our Insurance Commissioner does not do this now and Prop 45 will not give him the authority to do so in the future.

In fact, Prop 45 would simply apply the same regulatory framework to health insurance which has proven so successful regulating auto, home, and medical malpractice insurance in California. Auto insurance rates have actually decreased in the 26 years since Prop 103, saving Californians billions of dollars in premiums. In 2012, our state Insurance Commissioner actually saved doctors like yourselves over $44 million in excessive malpractice premiums using the very same system proposed in Prop 45.

With regard to special interests funding Prop 45, it is actually Big Insurance -- Kaiser Permanente, Well Point, and Blue Shield -- that is spending $37 million of our patients' premium dollars to try and kill Prop 45.
For every dollar that is spent on this campaign trying to protect patients against excessive, unreasonable health insurance rate increases, Big Insurance is spending almost 40 times as much to protect their lucrative status quo.

So, I urge you to stop spreading these lies. I challenge each of you to publicly debate the facts in person. Our patients are suffering mentally and physically from outrageous rate increases, and as the Hippocratic Oath makes clear, we must "keep them from harm and injustice." I call on you to renounce your opposition to Prop 45 and remember the promise you once made to all of your future patients.

Thursday, October 9, 2014

Should we provide health care for all? Does this woman deserve it?

I’m the welfare mom with a Coach purse

I know you're judging me, asking: How can you own a fancy purse when you can't afford your baby? Let me explain

Friday, September 19, 2014

Daughter calls Utah doctor a monster at sentencing

Associated Press

A Utah doctor convicted of murdering his wife in a case that became a true-crime cable TV obsession was sentenced Friday to 17 years to life in prison at a hearing in which his daughter called him a monster.

The long-awaited sentence came seven years after prosecutors say Martin MacNeill knocked out his wife with drugs prescribed following cosmetic surgery and left her to die in a bathtub so he could begin a new life with his mistress.

"My father's facade has now crumbled," said Alexis Somers, who asked the judge to give MacNeill the maximum penalty. "My father is a monster. He has never shown remorse for any of his crimes. He must be held accountable for his actions."

Judge Derek Pullan gave the 58-year-old MacNeill the harshest term possible: at least 15 years and up to life on the murder charge, plus one to 15 years on an obstruction-of-justice charge. A third sentence in a separate sexual abuse case adds another one to 15 years.

Pullan said the sentences must run one after the other, not at the same time. The Utah parole board will decide later whether MacNeill can be released after 17 years or must serve a longer term.

The one-time doctor and lawyer with a family of eight did not address the court during the sentencing...

Michele MacNeill initially was ruled to have died of natural causes, possibly heart disease, but her family hounded authorities until charges were filed five years after her death...
The judge pointed to Martin MacNeill's careful planning, saying he'd orchestrated the killing so his 6-year-old daughter would find her mother dead...

Tuesday, September 16, 2014

Doctor fires employee when she tells him she has cancer

Even before I read this, I had figured out that empathy and a desire to help others don't seem to be traits that medical schools look for when accepting students. And how did this doctor not know that it is against the law to fire someone for getting sick?

A Woman Told Her Boss About A Devastating Cancer Diagnosis. He Responded By Firing Her.
The Huffington Post
By Mollie Reilly

A Pennsylvania community is rallying around a woman who was fired from her job at an oral surgeon's office following her diagnosis with cancer.

Carol Jumper, who lives in Hopewell Township, Pennsylvania, was diagnosed with cancer impacting her pancreas, liver and ovaries in August. According to her fiance, Dennis Smerigan, Jumper received a letter from her boss, Dr. George Visnich, in which the oral surgeon said he was laying her off without compensation. Raging Chicken Press published the letter on Sunday.

"The symptoms of the disease, the pain medications you will need and the side effects of the chemotherapy will be significant and distracting,” reads the handwritten note, which bears Visnich's letterhead. "You will not be able to function in my office at the level required while battling for your life. Because of this, I am laying you off without pay as of August 11, 2014."...

Smerigan told the Beaver Countian that his fiancee worked for Visnich for more than 12 years...

Current and recovering cancer patients are protected against job discrimination under the Americans with Disabilities Act so long as the individual is able to perform the job's essential functions.

Kaiser Settles Lawsuit of Social Worker fired for reporting a death threat

Kaiser Settles Fired Social Worker's Lawsuit
Courthouse News
March 19, 2014

SAN FRANCISCO (CN) - A social worker who claimed that Kaiser fired her for reporting a death threat has settled her civil suit, a federal judge's ruling shows.

Robin Love, a licensed clinical social worker and certified alcohol and drug counselor, sued the Permanente Medical Group, Kaiser Foundation Hospitals and Kaiser Foundation Health Plan in U.S. District Court for the Northern District of California.

The November 2012 complaint alleged that a fellow therapist had warned Love that one of her patients had said he wanted "to murder Robin Love."

"For many months, Ms. Love requested that defendants obtain a restraining order on her behalf to protect her from the threatening patient," the complaint stated.

"Defendants failed to protect Ms. Love. When Ms. Love complained to several of Kaiser's managers about the ongoing violations of workplace safety and Kaiser's failure to protect her, defendants retaliated against Ms. Love by bringing false disciplinary charges against her, subjecting her to unlawful corrective action, and then terminating her employment."

U.S. District Judge William Orrick dismissed Love's whistle-blower and contract claims this past December but left intact her claims for discrimination, wrongful termination, emotional distress and other issues.

On Friday, he dismissed the case with prejudice, noting that the parties had announced a settlement after a conference with U.S. Magistrate Judge Elizabeth Laporte.

The matter shall be restored to the calendar, however, if either party certifies within 60 days that the settlement did not occur.

Details of the settlement are unavailable. Love's attorney Jenny Huang declined to comment on the dismissal. A Kaiser spokesman noted that the voluntary settlement did not include "any admission of any wrongdoing by any of the defendants."

One-fourth of bed alarms were broken before UCSD patient wandered away to his death

When Thomas Vera wandered away from UCSD to die in a nearby canyon in May 2013, executives across the University of California Health System were cutting positions of staff members who dealt directly with patients.

But those positions weren't cut because there was no money. The money was being shifted to administrators. It seems that the University of California's priorities have been shifting away from patient care to profit over the past several years.

But the greed of the executives and doctors at UC isn't the only factor at play in tragic patient deaths. I see another problem here, and we're all to blame for it. It's our refusal to talk about what should be done for terminally ill or injured patients. Sometimes hospitals are held hostage by families who demand miracles for their dying relatives. Losing a loved one is difficult, and some people can't accept the inevitable. They demand every test and treatment that might possibly give some short term benefit, and they even threaten to sue when their 95-year-old grandmother dies.

Few people want to talk about how to apportion health care dollars. The major exceptions to this are the vocal advocates of leaving large numbers of Americans without health coverage. In other words, these individuals want to let economics decide who should live and who should die. The advantage of this position is that it insulates its adherents from making specific choices about who should suffer or die. They want to let the market choose. Of course, the market is increasingly controlled by wealthy corporations and individuals who are taking a bigger and bigger share of the economy each year. The wealthy and their advocates apparently believe that fewer and fewer people should have health care.

Currently we spend an inordinate amount of money on the elderly during their last year of life, and, in particular, their last month of life. The truly disturbing aspect of this enormous outlay of healthcare dollars is that those who receive expensive hospital care during their final months have a lower quality of life than those who receive hospice or home care.

In the Archives of Internal Medicine, a study asked if a better quality of death takes place when per capital cost rise. In lay terms...the study found that the less money spent in this time period, the better the death experience is for the patient.

--Why 5% of Patients Create 50% of Health Care Costs?
Michael Bell

Obviously, if UCSD can keep the latest high-priced medical equipment in good repair, then it's perfectly capable of keeping bed alarms working. The California DHHS recently revealed some facts about the case of Thomas Vera, a UCSD patient who wandered into a nearby canyon and was found dead several days later:

State inspectors said the hospital failed to routinely test the buttons and failed to repair them when broken.

Prior to Vera’s disappearance, the most recent test had revealed more than 1 out of every 4 panic buttons at UCSD’s two main hospitals didn’t work.

--Broken Bed Alarm Blamed for Walkaway Patient's Death
By Steven Luke
NBC 7 San Diego
Sep 15, 2014

Is this the best that all these high-priced UC administrators can come up with? A patient dying of hunger, thirst and exposure in a nearby canyon? Obviously, UCSD can do better than this. AFSCME notes: "Care providers are forced to give special treatment to VIPs—so-called because of their wealth or relationship to UC administrators—at the expense of other patients."

It seems quite possible that Thomas Vera might not have recovered from his head injury even if he hadn't wandered away. He had apparently been in the hospital for weeks, too ill for surgery, and suffering from the delusion that he was being held captive in a garage in Texas. Perhaps he would never have become a good candidate for surgery. Would this man have had a better quality of life in his last days if he'd been in hospice care, or at home? It seems clear that he would have.

And would another person have benefited more from being in that hospital bed? It's hard to see how anyone could have benefited less than Thomas Vera did.

Perhaps UCSD administrators engaged in a chain of thought similar to these musings of mine when they created the situation that allowed Thomas Vera to wander off and die of exposure in a canyon. Did UCSD make a conscious decision to maintain expensive medical technology while neglecting low-tech life-saving gadgets for certain rooms?

The University of California has an enormous amount of political clout. Why not use that power for something besides making billions in profits from its health care system? Why not lead the discussion about how much of our health care resources should go to the terminally ill or injured?

A QUESTION OF PRIORITIES: Profits, Short Staffing, and the Shortchanging of Patient Care at UC Medical Centers
This report was written by AFSCME Local 3299 over the course of several months in 2012 and 2013. It is based on interviews with Local 3299 members employed at UC Medical Centers, reports by the California Department of Public Health, inpatient discharge data from the State of California’s Office of Statewide Health Planning and Development, as well as additional sources.

The public sees University of California Medical Centers as premier, world-class facilities. We rely upon them when our loved ones face the most serious illnesses because we expect them to provide the highest level of care. With the UC Medical System earning $6.9 billion in operating revenues and hundreds of millions in profits, it has the resources to do just that.

But recently, patient care advocates have witnessed something else: administrative decisions that prioritize UC’s profit margins over patients’ health. These decisions reflect a shift in values that reached a tipping point with a system-wide policy in 2011 that decentralized UC budget practices, and turned each medical center into an independent profit center.

This culture change is evidenced by a sharp rise in management salaries and compensation, excessive management costs, and unprecedented borrowing to construct new buildings.

Since 2009, management at UC Medical Centers has grown by 38 percent, adding $100 million to the annual payroll cost of management.

Debt service payments have almost quadrupled since 2006.

This diversion of patient care dollars results in management’s need to capture “efficiencies” to bolster profit margins.

While “efficiencies” can be positive, they can also have serious negative consequences. Often taking the form of aggressive cost-cutting measures, some translate into chronic short staffing, over scheduling of operating rooms, prioritizing “VIP” patients over everyone else, shortchanging charity care, and outsourcing essential services.

These degrade the medical centers’ core mission.

Care providers are painfully aware of administrative priorities that too often leave them unable to provide the care that patients deserve. Patient care workers suffer unnecessary stress and fatigue, and at times work without adequate training on the use of hazardous materials used to sterilize patient care areas. Some report being so rushed in their work that dirty patient care areas may not be properly sanitized before new patients arrive.

While workers are already feeling squeezed, the University is threatening to cut staff. At UCSF Medical Center, management recently announced its plan to reduce 300 hospital workers, or 4 percent of its full-time workforce. These reductions are being proposed at a time when the medical center is only just recovering from having to ration respiratory care services in January 2013 because of inadequate staffing levels. To make matters worse, the hospital’s CEO admits that, in his view, these cuts are needed, at least in part, to free up resources for new construction...

Frontline care providers give examples of how UC policies degrade safe staffing and patient care.

Patients often fall trying to go to the bathroom by themselves because short staffing delays staff response times. In one instance, a patient classified with “altered mental status” did not receive one-on-one attention and was found standing on a windowsill.

Chronic short staffing creates excessive workloads and stress. One nurse’s aide reports being afraid to take breaks because it would increase the ratio of patients to CNAs from 10:1 to 20:1.

The UC health system seeks to “re-align” Medicare and Medicaid patients to non-UC hospitals under the assumption that they often do not require the level of care UC provides.

Care providers complain about dirty patient care areas. An operating room assistant sees dried blood and fluids in the crevices of an operating table month after month...

Profitable high-level procedures get overscheduled, causing stress and exhaustion for care providers and delays for patients.

The State of California provides significant funding for the University’s Health System. In the fiscal year 2012-2013, it will provide approximately $300 million in public dollars for health sciences instruction....[Read more here.]

Broken Bed Alarm Blamed for Walkaway Patient's Death
Thomas Vera died after he became disoriented and walked away from his hospital room at UCSD Medical Center in May
By Steven Luke
NBC 7 San Diego
Sep 15, 2014

California Department of Health and Human Services records obtained by NBC 7 shed new light on what went wrong inside UCSD Medical Center when a disoriented patient walked away from his supervised room into a nearby canyon.

The [May 2013] lapse in hospital security led to a tragic search which ended when ...Thomas Vera’s body was found [several] days later less than a mile from the hospital entrance in Palm Canyon.

Family blames the hospital for allowing 58-year-old Thomas Vera, suffering severe head and neck injuries as well as [delusions], to leave the facility...

According to the CHHS investigation, Vera’s bed alarm never sounded. Vera was under video surveillance, and when nurses were notified, the report states they “attempted to contact security by paging security twice with no response and then pushing the panic button twice with no response.”

The panic button was “broken for 8 days,” according to the report.

State inspectors said the hospital failed to routinely test the buttons and failed to repair them when broken.

Prior to Vera’s disappearance, the most recent test had revealed more than 1 out of every 4 panic buttons at UCSD’s two main hospitals didn’t work.

“That’s incomprehensible to me. This is a big time, generally well thought of medical facility, and it’s like clown school” said legal expert Joel Brant, an attorney who specialized in elder care law.

[Maura Larkins comment: I don't believe they're clowns. They're clever, and they're calculating. The buttons were not a priority. UCSD pays huge amounts of money to maintain the equipment it wants to keep maintained. Were the walkaway patients paying full price? Were they a drain on UCSD financially?]

UC San Diego Health Sciences director of communications Jacqueline Carr released this statement in response to the incident:

“UC San Diego Health System underwent extensive internal and external investigations to identify the reasons that led to this tragic event...”

Fifteen months after the incident, CHHS says no fine or penalty has been issued as a result of the mishap...

Read more here.

Missing Hospital Patient's Body Found in Canyon: Officials
By Monica Garske and Dave Summers
Jun 1, 2013

The body of a missing hospital patient was discovered by search and rescue officials in a canyon Friday evening after an extensive search.

Chula Vista resident Thomas Vera, 58, had been missing since Monday. For the last several weeks, he had been a patient at the UCSD Medical Center.

Vera was admitted to the hospital after falling down the stairs at his home. He suffered a concussion and broken collar bone, according to his family, and was awaiting surgery...

Family, Cops Search for Missing Hospital Patient
By Brandi Powell, R. Stickney and Monica Garske
NBC 7 San Diego
May 31, 2013

A Chula Vista man, suffering from a head injury and broken bones, walked away from a San Diego hospital wearing only a hospital gown four days ago.

On Friday, San Diego police officers and family members spent all day searching canyons near Mission Valley for any sign of the man who officials say was likely disoriented and confused...

His daughter Tanya said Thomas last spoke with his wife on Sunday night.

"These are his words - he was being held in a garage in Texas - we're from Texas so he's thinking he's in Texas - that people were holding him against his will and drugging him, and so he was crying and telling my mom he was very scared," she said...

Saturday, August 30, 2014

Many Women Have Died Unnecessarily Because of surgery with MORCELLATORS

Why does Morcellation surgery continue when we know it kills women?   Why do doctors continue to do the surgery?  The answer: profits for medical device companies, profits for doctors.

How Many People Have To Die To Show A New Surgery Technique Isn't Worth It?
By Harriet Brown
Prevention Magazine
May 2014

Dr. Noorchashm asks: "When new technology makes
medicine cheaper and more convenient, how many
patients have to die to prove it's not worth it?"

Petition by Hooman Noorchashm, MD, PhD:

My wife [Dr. Amy Reed] had a surgical procedure that spread cancerous cells throughout her body. She now has stage 4 cancer. Please sign my petition demanding the FDA stop a procedure that has spread cancer in thousands of women.

My wife Amy is a mother of six, and an accomplished anesthesiologist who helped treat victims of the Boston Marathon bombing last year.

Now, because of a dangerous, but standard, gynecological procedure her early stage cancer was spread -- causing stage 4 cancer. 
Last Fall, Amy went in for a routine hysterectomy to treat what we thought were benign fibroids, and had a minimally invasive “morcellation” procedure to remove her uterus. Little did we know that this procedure would end up spreading malignant cancer cells throughout Amy’s belly. What's more is that “morcellation” is totally avoidable and it has devastated thousands of women and families by spreading and upstaging dangerous cancers of the uterus and ovaries. 
Now we’re taking a stand in hopes of banning this surgery for good, and saving the lives of countless women and mothers. And the momentum is on our side.
Because of the momentum of this petition, numerous hospitals around the country have stopped performing this type of hysterectomy. Last week, a major health insurer -- Blue Cross Blue Shield -- announced that they would no longer cover the procedure. And Johnson & Johnson, which manufactures some of the surgical tools used in this procedure, issued a worldwide voluntary recall of the tools called "power morcellators," saying that they couldn’t guarantee that the procedure was safe for women to undergo.
The reason this surgical procedure is so controversial is that doctors have no reliable way of testing whether patients are at risk of having cancerous cells spread throughout their body during the surgery. That was the case with Amy -- in the process of removing her uterus, undetected cancer cells were spread throughout her abdomen region, and stage 4 cancer developed. The same has happened to scores of other women, globally. Women who went in thinking they were having a “minimally invasive” procedure, left the operating room with an advanced stage of cancer.
Last month, the FDA held public hearings on this surgical procedure. Amy and I traveled down to Washington, D.C., to talk about this petition and to bring Amy’s story to the attention of FDA and congressional regulators. They are currently debating whether to ban this procedure or not, and that’s why I need your help today.
I cannot tell you what this means to my wife, to me, and to our family. Together, we can help potentially save the lives of thousands of women moving forward. No other woman should ever have her uterine cancer upstaged to an advanced stage by a gynecologist practicing this totally avoidable procedure they call "morcellation."
Thank you,
Hooman Noorchashm, MD, PhD
Boston, MA

Health Alert: Many Women Have Died Unnecessarily Because Dangerous Cancers of the Uterus and Ovaries Are Being Spread using MORCELLATORS. Stop MORCELLATION in Minimally Invasive Gynecological Surgery. 

Friends of the Public,

Many women have been harmed and have died prematurely or unnecessarily because of a routine but avoidable gynecological practice known as MORCELLATION. This world-wide practice has devastated many families for well over two decades now.

More than 600,000 hysterectomies are done in the US every year. By the age of 70, one out of every three American women will have had a hysterectomy. About 90% of these surgeries are done for what is presumed to be a benign condition called fibroids. More and more of these surgeries are done with minimally invasive techniques.  Usually, to get the uterus out of the body using the "minimally invasive" technique, it is cut into small pieces with a machine called a morcellator.  However, a devastating problem happens if in fact the woman did NOT have fibroids – but if she actually had cancer.  Unfortunately, the tests that are done before a hysterectomy do not identify these cancers well.  Many gynecologists don't even bother getting any tests. In fact, morcellating cancer spreads the cancer inside the woman’s body.

This is called ‘up staging’ the cancer.
It is important to understand:

1) The average life span following accidental morcellation of sarcoma is only 24-36 months.
2) Only 15% of woman who have leiomyosarcoma (LMS) that has spread (stage 4) will be alive after 5 years.
3) Women with sarcoma who are morcellated are about 4 times more likely to die from sarcoma than if they had not been morcellated. 

This is an avoidable disaster.

This problem has been recognized for more than two decades.  A review of the literature reveals that 1 in 415 women who go for fibroid surgery actually has sarcoma.  This means that everyday 2-5 women in the US – and more around the world will have a deadly cancer spread because of morcellation.

This catastrophic problem has happened in our own family and we are fighting to stop this dangerous activity called morcellation.  A chance of 1 in 415 for such a devastating outcome is much too high to accept.  Women should be told the truth and the practice should stop.
Please help us bring an end to spreading cancer with morcellation.  There are alternatives.  Some surgeons have begun using a special bag to avoid spreading cancer cells.  Several of the reasons why this has not yet become commonplace are the fact that: a) bag morcellation takes more time – and time is money; b) lack of training; and c) lack of awareness.  Other people opt for a traditional open hysterectomy.  People need to understand their options – but – currently, most women never hear anything about morcellation or about the possibility of cancer upstaging. We need your help.
Please sign our petition so we can get the word out.  We want the American Congress of Obstetricians and Gynecologists and the American Board of Obstetrics and Gynecology to change this "standard of care" by ending the needless waste of life caused by spreading cancer with morcellation.

For more information and original references see: ) (also see: (also see:
The attached video below shows an example of morcellation

The following companies manufacture and distribute uterine morcellator devices:

1) ETHICON: Gynecare morcellator
2) Storz: Rotocut Morcellator
3) Richard Wolf Medical Instrumentation Company
4) LiNA: LiNA Xcise Cordless Laparoscopic Morcellator
5) Blue Endo MOREsolution Tissue Morcellator

Intuitive Surgical's Da Vinci Robot deserves special mention, as the frequency of robotic hysterectomies performed by minimally invasive gynecologists is currently on the rise across the United States. Note that Intuitive Surgical builds and markets the DaVinci robot, which is not itself a "morcellator". However, use of the DaVinci robot almost invariably appears to require that the uterus be minced up, or morcellated, into smaller pieces inside the woman's belly cavity in order to extract from the abdomen. A clear example is shown in the following YouTube video of DaVinci being used to perform a robotic hysterectomy and manually morcellating the uterus using the endo-wrist component of the robot (morcellation is being performed at minute 5:30 of the video).

 Without morcellation using equipment manufactured by Intuitive Surgical, robotic hysterectomies would, likely, not be possible using the DaVinci Robot. It is noteworthy that the DaVinci robot does not appear to have a readily available warning label advising against its use to morcellate tumors with malignant potential inside the body. The company's Chief Medical Advisor, Dr. Myriam Curet, a surgeon herself, has been informed and advised of this severe hazard in the use of DaVinci for robotic hysterectomy and the absence of a readily available warning label.