In Prince's Age Group Risk of Opioid Overdose Climbs at Middle Age

This is related to the previous post about the increasing number people dying in middle age due to toxic poisoning.  Evidence is mounting that Prince may have died of a drug overdose. While the medical examiner hasn't yet released the results of the autopsy and toxicology scans in this case, opioid overdose in middle age is all too common.

In 2013 and 2014, according to the The Centers for Disease Control and Prevention, people ages 45 to 64 accounted for about half of all deaths from drug overdose. Prince died on April 21 at his home and music studio, Paisley Park, in Minneapolis. He was 57.

There are a number of scenarios that explain the increase risk of overdose, which is often accidental, for people over 55.

Imagine you're in your 50s. You injured your shoulder a while back and it just hasn't gotten better. You take prescription painkillers — an opioid like OxyContin — to help with the pain. Let's say you've been taking it for a couple of years. Your body has built up a tolerance to the drug, and now, you need to change it up to get the same amount of relief.

When it comes to the potential for overdose, says Boston Medical Center epidemiologist Traci Green, this is one of the most dangerous crossroads.  "We oftentimes see that the dose will increase with an individual over time or they might rotate or switch to another medication to experience pain relief. And so, at each rotation or change, there's a risk [of accidental overdose] because you're moving from one drug to another," she says.

Read more about the why this age group is more susceptible to overdose:  http://www.npr.org/sections/health-shots/2016/05/05/476902228/risk-of-opioid-overdose-climbs-at-middle-age

Ethical Issues in Healthcare

On April 21, we discussed genetic testing and efforts to personalize medicine by knowing DNA and personal details about your health over time.   In addition to these topics, what other ethical quandries are there to consider?  I provide some links below, but you are welcome to post about events in the news and on documentaries.  These are just ways to get you started.   When it comes to healthcare, nothing is simple.  Consider the moral and ethical issues related to it.

There are many good resources on our blogroll and here:

• Propublica.org
• Center for Public Integrity (http://www.publicintegrity.org/health/) 
• NYTimes/Health (http://www.nytimes.com/pages/health/index.html) 
• NPR/Health (http://www.npr.org/sections/health/) 
• Center for Investigative Reporting (now called Reveal @ http://www.revealnews.org/topic/healthcare/) 
• Recent Frontline special on "Supplements and Safety":
• The booming 30-billion-dollar-plus vitamins and supplements industry says these products can make consumers healthier — but a new FRONTLINE investigation with The New York Times and the Canadian Broadcasting Corporation raises troubling questions.  Supplements and Safety investigates the hidden dangers of vitamins and supplements — exploring how they’re marketed and regulated, and how it’s often hard to know what’s really in the bottles you buy.

In the blog, provide a link to the article/video and summarize the main points.  Offer any recommendations mentioned  in the article, or your own personal opinion about what should be done to address the topic.

How Doctors Helped Drive the Addiction Crisis

We covered this topic in "Escape Fire" and we read about alternatives to treating pain with acupuncture.  Last semester I read this opinion from the Sunday NYT paper on 11/8 and decided to blog about it (than post it on FB).   It is also related to the topic we just covered. The article begins by asking, why is there an "alarming and steady increase in the mortality rate of middle-aged white Americans" since 1999? According to a study published last week (short pdf; read it), much of the excess death is attributable to suicide and drug and alcohol poisonings. Opioid painkillers like OxyContin prescribed by physicians contribute significantly to these drug overdoses. Here are two figures from the study that speak to the issue (click for a larger image):

 "Driving this opioid epidemic, in large part, is a disturbing change in the attitude within the medical profession about the use of these drugs to treat pain." The article states that the rate of death from prescription opioids in the United States dwarfed the combined mortality from heroin and cocaine, and an increasing use of . At the time this was shocking news.  Now the link to opioids to heroin What surprised you? Any remedies? Read the links and comments by others for some further thoughts. Read it here...

Few Americans Follow 4 Main Pillars of Heart Health

Most Americans know that a heart-healthy lifestyle includes eating a healthful diet, not smoking, being physically active and keeping weight and body fat down. But a new study found that fewer than 3 percent of American adults could claim all four healthy elements.

The study, published in Mayo Clinic Proceedings, was based on data gathered from the National Health and Nutrition Examination Survey from 2003 to 2006 and included a nationally representative sample of 4,745 Americans.

Do you think these finding would still be the same percentage today?  Why or why not?

You can read the short article and many comments, published on 3/24/16 in the NYTimes.

The AI Doctor Will Hear You Now

There are so many articles now on AI in medicine, it's no longer about just about IBM Watson.  Here's an article in MIT Tech Review from 3/9/16.  After all, some diagnoses are better down with an algorithm than with the human mind.  For example, there are about 10,000 known human diseases, yet human doctors are only able to recall a fraction of them at any given moment. As many as 40,500 patients die annually in an ICU in the U.S. as a result of misdiagnosis, according to a 2012 Johns Hopkins study. British entrepreneur Ali Parsa believes that artificial intelligence can help doctors avoid these mistakes.

Read the article... Can you find other examples of AI in Medicine (besides Watson, of course)?

Parsa is the founder and CEO of Babylon, a U.K.-based subscription health service that plans to launch an AI-based app designed to improve doctors’ hit rate. Users will report the symptoms of their illness to the app, which will check them against a database of diseases using speech recognition. After taking into account the patient’s history and circumstances, Babylon will offer an appropriate course of action. Currently in beta testing, the app is expected to be available later this year.

Cleveland Clinic and Patients First!

You have a week or so to post and reply to comments about Healthcare's Service Fanatics and the newer HBS Case: Cleveland Clinic: Growth Strategy 2104 (pdf of the cases). Due by Thursday, Mar. 3.  We will discuss this in class  

Synopsis: From the HBR article and the Case Study, the CEO at the Cleveland Clinic, Dr. Delos "Toby" Cosgrove’s central message to employees had been Patients First!, which demanded relentless focus on measurable quality.

“This included constant attention to patient safety, respect for the patient’s dignity, excellence in housekeeping services and facilities, and genuine concern for the patient’s emotional wellbeing and care experience.”

Dr. James Merlino became Chief Experience Officer in 2009. Merlino defined the patient experience as "everyone and everything people encountered from the time they decided to go to the Clinic until they were discharged.” He worked to make patient experience insights more tangible by asking the question: “How can processes and metrics drive improvements in the patient experience.” As you read the case, consider the following: (You can write it as a paragraph and include any issues that stood out for you as you read the case. These questions are mostly to serve as prompts for your thinking.)

1. What is the Cleveland Clinic’s overall strategy for improving value for patients?
2. Are there examples of what Cleveland Clinic are doing well, or areas where they may still need improvement?
3. What do you think of other efforts linked in the class schedule, or examples of your own, that make you feel like there is a “patient first” transformation in place or are you skeptical? Explain.

Health IT Usage Behavior and Patient Safety

I recently read a report that offered a theoretical model of health it usage behavior and implications for patient safety.   The authors chose to focus on theories that could explain clinician HIT usage behavior because of the widely observed underuse and misuse of HIT and the associated patient safety consequences.  They claim it is important to understand that poor system design, through its effect on behavior, is the root of the problem.  That is, poorly designed systems facilitate or even encourage behaviors that may be contrary to expectations, policies or goals, and the models presented here make clear that the exogenous variables are system design factors.

Perhaps the most obvious case of a HIT whose efficacy suffers from underuse is that of medical error/incident reporting systems: up to 96% of medical errors are estimated to go unreported. Briefly, reporting systems are paper-based or electronic systems used by health care providers to report in some detail the occurrence of safety-related events. These events, depending on the system, may be instances of patient harm, near-misses, preventable errors that lead to harm, detected hazards that may lead to future harm, or combinations of these. Although reporting can have various purposes, the two main ones are learning and system improvement. As an example, consider a health care organizations that foster a culture of blame and shame, not only are needs not being met, but reporting may threaten vital needs. This is illustrated in Figure 1 below, where primary needs on the hierarchy are jeopardized when one reports in a blame culture. Examining Figure 1 provides a motivational explanation as to why many studies find that fear of punitive consequences deters many clinicians from reporting, whereas ethical obligations, small rewards, and a positive reporting culture tend to be motivators.

Figure 1. Needs met and jeopardized by the reporting of medical errors in a blame culture 

Here is a video that explains what happens when cultures move from blame to identifying root causes of the problem.