Author: Ann Marie Marciarille

It is a mystery to me why a statement from the FDA warning of the overly aggressive use of surgical robots in procedures for which they do not have FDA approval does not receive more press coverage.  I'm talking front page headlines: Know the Risk of Robotic Surgery for Your Mastectomy — that kind of thing.

I love the widely circulated idea that once patients are empowered to ask their providers about this risk (how would they know to ask?), they will be empowered to stem the tide of FOMO (fear of missing out) that drives surgeons to use these surgical robots even when the data indicates worse outcomes when doing so.  So, what drives FOMO in surgeons?  Partly, I suspect, FOMO is driven by patient desire for ever smaller incisions and shorter recovery times.  But, I don't think that is the whole story. 

Part of what is going on here is a practice environment that, with few constraints,  allows surgeons to experiment on their patients, without disclosing the experimental nature of the treatment and obtaining  consent to human subject research. 

After all, if a great many surgeons are doing it, it must be safe and non-experimental, right?

Ah, the wonders of HIPAA are, in part, laid bare by recent, apparently surprising , news that  wellness apps are not providing or exchanging personally identifiable health information with their users, so almost anything goes with the unannounced circulation of information collected there. HIPAA's privacy rule targets personally identifiable health information, after all. 

So, that app designed to help you lose weight by tracking inputs like activity level, weight at various intervals, food intake, etc. isn't really obligated to ask your consent to have your data accessed by those interested in advertising, marketing, as well as research.  Of course, the greater fear is that such information will soon be of interest to insurers and employers.  But it already is.

Were you on dorm crew?  I suspect your answer to that question might tell me much about you, perhaps more than you care to reveal.

I was on dorm crew — the best paying campus job I could find at Amherst College.  In fact, I believe I was only the second woman to be on the crew.  I was in the third coed class at Amherst, after all.

Dorm crew, seen from one perspective, is the flip side of college admissions-gate, the dirty underbelly of how elite schools only begrudgingly make room for those who are not well-sponsored or well-connected, and certainly not well off.

So, were you on dorm crew?   

 

That a fast moving fungus, Candida Auris,  should have infiltrated significant numbers of U.S. Hospitals with nary a report to the public may not come as any surprise to you if you read my paper on the U.S. Hospitals culture of omerta when it comes to health care associated infections. And, this will not stop here.

The state specific and county specific data on health status and health outcomes is posted here.  If you look into Missouri, as I did, you find the most consistently poor health status and poor health outcomes in Missouri's Bootheel. Missouri has a Bootheel that, historically, has been populated by tenant farmers. The lack of big cities means the area is predominantly rural, with the sketchy health care status that comes with it. It is said that this is the part of Missouri  that is the most like Arkansas. Arkansas, of course, has its own health status issues.

The New York Times certainly wishes it were, meaning being called to account for seemingly reprehensible sales and marketing practices.  Is the measure of the zeitgeist whether the CEO's of these companies have been called to explain themselves before Congress? Maybe. It may also be whether the industry's reputation is tarnished in the public mind. As to the latter: can you forget one of the last scenes in the movie version of "Thank You for Smoking" where the pharmaceutical industry rep is huddling with the other shunned industries such as Big Tobacco. Or, how about the very recent finale episode of season four of the series Catastrophe where the Rob character (played by Rob Delaney) continues to hate his job for a pharmaceutical company when the new top dog  (played by Chris Noth) comes to visit the local offices, he is gleeful over the increase in Syphilis cases as a burgeoning market for one of the company's drugs.  Syphilis good, right Rob?

Oh, I'd say we're at peak Tobacco moment with the pharmaceutical industry right now.

Health Affairs has an interesting recent  article about coding for social determinants of health by Douglas Olson, et al, arguing that standardization of these efforts in the "Z Codes" of the ICD-10 will make tracking of such codes, patients, and data so much easier.  The responses in the comments illustrate how diverse current attempts are at coding for social determinants of health.

But why do this?  One comment makes it clear that it levels the ground on risk adjustment for  safety net hospitals in readmissions, for example. A worthy concern? Yes. A patient foremost concern?  Not really.  And that's the double edge of coding. Is it about better patient outcomes or better provider bottom lines?

 

 

 

Anthem has launched a pilot project in conjunction with Indiana Legal Services to fund legal assistance to all Medicaid beneficiaries in a limited geographic area.  This is worth watching. Medical-Legal partnerships, often funded in whole or in part by providers, have been  around for a few decades, helping those individuals known to the partnership's providers in need of legal assistance, quite often with Medicaid eligibility.  You can see that the breadth of the assistance offered is much wider in this pilot project: housing, income support, access to addiction services, etc.

Of course, no program funded by an insurer is likely to assist in a claim against the insurer, say: an appeal of a denial of benefits, or is it?

The authors of the Upshot article on the many shades of "Medicare for All" at the NYT have performed us all a service by attempting to show five different important policy and design distinctions inherent in refining a definition of "Medicare for All."  The only the part that is missing is showing what relationship whatever topic is being discussed bears to Medicare as we currently know it. For instance, Medicare as we know it, does not have automatic enrollment yet carries substantial penalties for late enrollment. It would be useful to see what percentage of respondents would like that carried over to "Medicare for All"– either in the interests of intelligent plan design or political palatability.

Listening to Yoruba Richen talk to Terry Gross on Fresh Air today, I learned that The Green Book for African-American motorists also served to provide local information on health care access for those excluded by the race.  I  can only imagine  that it was useful for African-American  cross country travelers to know that Kansas City's Wheatley-Provident Hospital (1916-1972)  was open to them. Wheatley-Provident was a symbol of African-American accomplishment and of Kansas City's sorry history of health care segregation, with its African-American professional staff at all levels. As this building is about to be reincarnated into office space, I hope Kansas City finds room to tell its story and embed its meaning in the city's narrative.

Not that de-segregation of health care was uncomplicated.   Barbara Berney's documentary Power to Heal tells the story of how the federal government used Medicare dollars to end the practice of racially segregating patients, doctors, medical staffs, blood supplies, and linens.