A Tale of Three Doctors

Woke up one day this week to read about how the medical profession was  put in a rather unfavorable light, in various parts of the globe.

In Los Angeles,USA, it was reported that the late Michael Jackson’s doctor, Dr Conrad Murray, who practises in Houston was going to be charged in a few days time  for involuntary manslaughter. It was alleged that the doctor had administered the powerful anaesthetic drug, propafol, plus two other sedatives in a concerted attempt to make the pop star go to sleep. Propafol needs to be administered intravenously by an anaesthesiologist in a hospital setting and requires continuous monitoring as the drug can cause suppression of breathing, lowering of heart-rate and blood pressure. See my earlier posting “MJ’s Death Explained“ for details.

Dr Daniel Ubani - still practising in Germany

In Cambridge,UK, a foreign-trained doctor, on his first work assignment for the NHS after arriving in the UK the day before, administered an injection of diamorphine (an opioid used for pain relief) of twenty times the recommended dose to an elderly patient at his home for relief of kidney pain. Not surprisingly, the patient stopped breathing soon after the doctor had left. At the coroner’s enquiry, it was discovered that the doctor, originally from Germany, had failed his English test earlier and had never given the drug before. It was also not possible to extradite the doctor from Germany to face charges, where latest reports say he is still practising.

Dr Suresh Nair -1991 Sydney Uni graduation pic

Meanwhile, in Sydney,Australia, a neurosurgeon has been charged over the cocaine-related deaths, in November 2009, of two young women who had visited his apartment. Post-mortem results showed both women had died of cocaine toxicity. Having been suspended by the New South Wales Medical Board, he now remains in custody pending trial. Some unanswered questions remain, like having been a known cocaine abuser since 2004, why was he still allowed to practise by the Medical Board?

Having read these stories, I just wonder whether this is a trend of things to come, or whether the virtues of a noble profession are being eroded in the face of changing times? Perhaps, most tellingly, when I asked a student who had aspirations of being a doctor, why he had chosen the profession, his answer was,“ So that I can make a lot of money!”

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So What Errors Can Hospitals Make?

An article in the Los Angeles Times attracted my attention recently. Datelined January 28 2010, it reported that the California State Department of Health had fined 13 hospitals for committing medical errors  that in some cases seriously injured and even killed patients.

Some of the errors included:

-the death of a patient  who was supposed to be restrained and supervised, but was instead left to repeatedly pull out his tracheotomy tube until he was found unresponsive in his bed.

ICU Monitors are Indispensable..but require monitoring too!

-intensive care nurses failing to monitor a woman’s oxygen levels; the patient passed out and had to be placed on a ventilator.

-the death of a patient treated in the emergency room for a heart attack where nurses failed to notice that the man’s heart monitor had disconnected and the volume on the patient’s heart monitor alarm was not loud enough to alert staff.

-staff leaving a surgical sponge in a patient. She got so sick she had to undergo a second operation.(Yes,people, it also happens in the US!)

But perhaps the most bizarre medical error reported was the case of a patient on a metal stretcher being sucked in by an MRI machine’s magnetic force, resulting in the patient  fracturing her leg and foot. Just so to remind ourselves that such MRI-related injuries are not uncommon, a similar incident was shown in Episode 15 of ER which was screened a year earlier in 2008!

Clip from ER,episode 15: note the patient sandwiched between the metal stretcher and the MRI machine

MRI scans have gained in popularity in the last decade with its crystal-clear images and with no radiation involved. It uses magnetic waves instead, but the strength of these waves can be as much as 50,000 times the earth’s gravity. So much so, any metal objects within distance can be pulled with such force to the machine’s magnets to be able to cause serious injuries. Incidents such as scissors flying and oxygen canisters hitting with such force to cause fatal injury have been reported. Not to mention the data on credit-cards being wiped out  to render them useless! In fact, those with heart pacemakers and certain artificial heart-valves are usually not permitted to undergo MRI scans.

Yet, despite risk reduction strategies and safety protocols, such untoward incidents do continue to happen. One of the main reasons for this is that many – including healthcare workers -are unaware that the magnets in the MRI scanner are always “on” even though there are no patients inside.

Read here to find out more on the Joint Commission’s recommendations for MRI safety procedures for healthcare workers.

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Healthcare Costs: Barking Up The Wrong Tree

If you have been following the progress of President Obama’s proposed healthcare reforms, you would have noticed the numerous obstacles and protracted course it has taken. When he first mooted it during the presidential campaign, Obama the Democrat stood for government to provide healthcare for everybody by expanding the role of the existing Medicare into a compulsory public insurance scheme. This has now metaphosised currently into two Bills to be considered in Congress: the House Bill and the Senate Bill, both with differences. But whatever the Bill, Obama had to backtrack by accommodating private insurance companies; with the proviso that they would operate in a single insurance exchange incorporating public insurance schemes.

Too Much Emphasis On Who's Paying For What!

Why is this important to all of us outside the US? Quite simply, healthcare is a massive trillion dollar industry in the US and whatever happens here is bound to affect the rest of the world. Meanwhile, as the bureaucrats and politicians mull over what’s next,  healthcare delivery seems to be spluttering along. Take for instance, the plan to close the only acute care hospital in Greenwich,NY (St Vincents) because of insurmountable debts (see here). This has understandably created a strong protest from the local community.

St Vincents Hospital,Greenwich Village,New York - in near-bankrupcy and facing imminent closure as an acute-care facility (pic from New York Times)

Elsewhere, I wrote in a recent posting about the plan to close the Royal National Orthopaedic Hospital in London for very much the same reason – soaring expenditure well over budget.

If we look at the healthcare reforms in the US or Great Britain, the question regulators need to ask is not who’s going to pay for the costs. The bigger question should be : how to reduce costs?

There’s a growing feeling that not enough attention is being given to look at ways and means to bring expenditure down. Rather, more attention seems to be  devoted in identifying the payors. Should not more focus be given to minimising duplication of services for  a particular geographical region to enhance efficiency? Or capping the litigation costs and awards for medicolegal suits? Or enhancing the usage of generic drugs that have proven efficacy?

Many of these measures will generate strong opposition from vested parties, but since the health reforms are about fundamental rights to healthcare, it would seem logical that the wellbeing  of the public should override the interests of those with vested interests, like  big pharmas and private insurance companies, for instance.

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Some Healthcare Predictions for 2010

Let me state upfront a disclaimer that I am not a soothsayer or fengshui expert, but some healthcare trends which I can forsee this year were already ‘works in progress’ and therefore have a high chance of seeing the light of day in 2010.

1.Cutting Down The Salt - nothing new, you might say; but recent evidence in the New England Journal of Medicine shows that reducing salt intake to 1 rounded teaspoon daily would “prevent up to 120,000 heart disease cases, 66,000 strokes, and save 92,000 lives in the USA alone every single year.” So, there is a renewed push by health authorities to push for a reduction in the amount of salt in packaged and restaurant foods by 25 percent over the next five years.

2.A Renewed Anti-Smoking Campaign- while the dangers of smoking are widely accepted and smoke-prone countries like India and Turkey have banned smoking in public in 2009, the frontiers where smoking is banned in bars and restaurants will be pushed even further. Such a ban has been imposed this year, for instance, in North Carolina, the leading tobacco-producing state in the US and home of R J Reynolds. Pretty unthinkable a decade ago! Other countries have begun to raise the prices of smokes (quite ineffective, I must say) and even put vivid diseased organ pics on the packs.

3.A Ban on TransFats – eating foods containing transfats, such as french fries, doughnuts, pastries and cookies, causes the bad LDL cholesterol to go up and the good HDL cholesterol to go down,  leading to an increased risk of stroke, heart attacks and diabetes. I think we can see a consumerist movement towards banning  transfat coming up. In fact, in California, restaurants are banned from using transfats beginning this year.

A Quick Look at the Back of the Package will reveal Transfat Content

4.Stem Cells Galore- the progress in using undifferentiated cells to morph into tissues and organs seemed to have spluttered the last decade. But this year should see the explosive use of this technique to repair damaged tissues and organs. Ranging from damaged joints to breast enlargement, the demand is set to rise with improved techniques, such as using one’s own cells (autologous method).

Stem Cells obtained from the abdomen is processed and injected for breast enlargement

5.Surge in Rejuvenative Medicine- whereas people were content  initially to just look good and resorted to cosmetic surgery to achieve this, now there is awareness  to also feel good – hence the popularity of antiaging medicine with physical and mental enhancement techniques.

Reading,Writing and Sending SMS While Driving -a Universal Ban Soon?

6.Ban on Texting while Driving – using mobile phones have been blamed for many traffic accidents, but the increasing popularity of sending texts may account for more accidents than talking on the mobile( well, at least your eyes are still on the road!). More states in the US (19 to date) have now started to ban texting while driving. This is likely to be the trend in many other countries as well.

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Medical Marijuana – the Momentum Multiplies

To the casual observer, it would seem surprising that marijuana would be legalised under the Obama administration. Law-enforcers will apparently not arrest users and sellers of marijuana (aka weed,grass,cannabis,hashish,ganja) – provided they conform to US state laws on its use for strictly  medical purposes.

A legalised marijuana dispensary in Oakland,Calif - authorities in LA are clamping down and closing 475, leaving only 70 in 2010

New Jersey became the latest  USA state to allow its medical use, adding to the 14 which had done so earlier. Unlike California,  where doctors are authorizing patients to take marijuana to relieve such minor ailments as anxiety, headache, premenstrual syndrome, and trouble sleeping,  New Jersey has tightened regulations to allow its medical use only for people who have less than a year to live, or those with specific symptoms resulting from certain chronic diseases like AIDS, cancer and Crohn’s.

Marijuana tincture - early 20th century pain relief

Marijuana has been used medicinally  as an intoxicant for thousands of years in Eastern culture. In Western medicine, several well-known pharmaceutical companies, including Eli Lilly , sold cannabis in powdered or tincture forms in the early 20th century as a painkiller, antispasmodic, sedative, and “exhilarant.” Since then, its use declined because more effective drugs for these purposes became available.

Now, researchers have shown its usefulness  in the treatment of neuropathic pain (intense pain due to nerve damage), improving nausea and poor appetite in patients on chemotherapy as well as releasing muscle spasms in patients with multiple sclerosis. While medical research has been slow, (researchers are finding it difficult to get the plant legally and to get permission to undertake such research), its medical use remains controversial in many areas other than the few indications above.

Wishful Thinking - Proponents of Legalising Marijuana Hope To See This Kind of Outlets!

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Health Hazards in Haiti Are Just Beginning…

The news of the enormity of the earthquake that hit Haiti on 12 January has been rather muted up till now, maybe because of the difficulty in establishing proper communication channels. There is even a page on Facebook called Earthquake Haiti for people to look for the missing. But consider the following:

-estimates of deaths may reach 200,000.(the 2004 Indian Ocean tsunami caused about the same number of deaths)

-a large number of foreigners are missing, including 1,415 Canadians.

-75% of the capital Port-au-Prince has been destroyed.

The Presidential Palace - Totally a Write-Off

The Injured Being Treated Outside the Damaged 'Doctors Without Borders' Clinic

Added to the misery is the fact that only 2 hospitals are operational, the rest destroyed, including the 3 clinics run by Doctors Without Borders. This is on top of the fact that there’s no running water,  no sanitation,  no food, and no electricity.

While the immediate health problems are obvious to the 3 million Haitians that need urgent medical help, the real challenge will come in the weeks ahead when diarrhoea, lung infections and complications of chronic disease set in because of the poor sanitation, nutrition and inferior medical facilities.This is when international agencies like the WHO and Red Cross can lead by example, just like when they did it for the H1N1 pandemic. Perhaps they can do it with the same resolve,urgency and resource?

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Why the US is Not Opting for a Government-run Healthcare Scheme

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If You Can’t Beat Them, Join Them..Then Beat Them!

Even if you have never heard of the Royal National Orthopaedic  Hospital (RNOH) located in north London, it doesn’t take too much to gather that it is a national healthcare institution revered by the British. The RNOH is one of the world’s leading orthopaedic hospitals and treats 60,000 patients a year. The big problem is this ageing hospital is in a chronic state of disrepair and costs millions of pounds to maintain every year.

The RNOH in Stanmore,Middlesex - leaking through the roof as well as the budget

The hospital is the single biggest employer in the constituency, but nearly two-thirds of the buildings are pre-fabricated pre-war structures. Water leaks through the ceilings while surgeons operate on patients (I know a few recently-constructed hospitals which are doing the same!), and the maintenance backlog is running at an estimated £54m. The NHS trust, which owns and operates the RNOH figures it would be in the best interest (whose?) to decentralise the hospital services and shut down the current one, so that it would be more economically viable.

Prof Tim Briggs..taking on the Labour MP on a single-issue campaign in the next General Elections

Well, not if Professor Tim Briggs, medical director of the RNOH, can help it. He intends to challenge the former health minister Tony McNulty as an independent candidate for Harrow East with the aim of securing the future of the renowned institution. Despite intense lobbying the last 15 years , he has not got the required £60m from the NHS despite the support of the Prime Minister and successive health ministers.

Now, Professor Briggs is applying to the electoral commission to register his new political party, the Central Party for Reform, before he takes on the incumbent Labour MP.

And his chances of winning? Going by precedence (In 2001, Dr Richard Taylor unseated the incumbent Labour MP  when he fought to save Kidderminster hospital), he does appear to have the upper hand..

Read more about it here.

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Quote For The Year 2010

People are so worried about what they eat between Christmas and the New Year,

when they should be worried about what they eat

between the New Year and Christmas.

Having said that, I would like to wish you a great 2010 as we enter the new decade..

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Doctor2008’s Top Health Stories of 2009

Its that time of the year again, so here’s my list of the healthcare stories that made the headlines in 2009.

1. The Swine Flu Epidemic- what started off as an outbreak of Swine Flu in Mexico in April was quickly metamorphosised by the WHO to AH1N1 infection and upgraded to a pandemic by administrative redefinitions. We may never know how serious this could have been, despite the reported 22,000 or so deaths, because of the intensive preventive measures, greater awareness and borderless cooperation.

Obama-health reforms pushed through-but at what cost?

2. Health Reforms- sure, this was about the United States, but the global impact was tremendous because the US is the world’s largest economy and many nations were watching to see what impact the reforms would have on them as well as, possibly, how they would tackle the problem themselves, in the face of rising costs of healthcare.

3. Drug Misuse & Celebrity Deaths- the deaths of Michael Jackson (see my blog posting ) and Brittany Murphy (see here) due to the untoward effects of prescription drugs highlighted the effects of drug interactions, especially with prescriptions obtained from multiple sources. After Anna Nicole-Smith in 2007 and Heath Ledger in 2008, is enough being done?

Brittany Murphy - latest in a long line of drug-related celebrity deaths

4. Mammograms & Breast Cancer- this diagnostic tool for early detection of breast cancer took a hit in the chest (pardon the pun) when the American Cancer Society released data that women in their 40’s do not require routine annual mammograms, going against the established ’standard’ practice of many years.Read here.

5. Acetaminophen(Panadol,Tylenol) Trouble- what was considered a safe household pill available over-the-counter came under FDA restriction in its use with the reduction of its recommended dosage in view of liver problems. Read my posting here.

Electronmicrograph of brown fat

6. Good & Bad Body Fat- the discovery that ‘brown fat’ found in babies (needed to keep them warm) and found in minute amounts in adults was able to make adults lose up to 9 pounds yearly( if this fat was activated) without diet or exercise, has led to a research race to come up with a commercially viable product.See here.

7. Octuplet Mum- was it a breach of ethics by the obstetrician to allow a single unemployed 33year old mother of six to have eight babies by artificial fertility techniques?You decide..(read more here)

33 year old Nadya Sulaiman -eight babies at one go to add to the six

8. New Blood Test for Heart Disease- used for many years, C-Reactive Protein test for diagnosing active heart disease  was notoriously nonspecific as a lot of other conditions also caused elevated values.A more accurate test, hs-CRP is now available.

I’m leaving the last 2 slots vacant because, in my book, there hasn’t been that many significant stories in 2009 – unless somebody can prove me wrong!

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