05 November 2014


Original Story: nydailynews.com

Like this move by Facebook founder Mark Zuckerberg.

The social media czar and his wife Priscilla Chan are donating $25 million to help the Centers for Disease Control fight the Ebola epidemic.

“We need to get Ebola under control in the near term so that it doesn’t spread further and become a long term global health crisis that we end up fighting for decades at large scale, like HIV or polio,” Zuckerberg wrote on his Facebook page on Tuesday. “We believe our grant is the quickest way to empower the CDC and the experts in this field to prevent this outcome.”

Zuckerberg’s donation will be used to fund the CDC’s efforts to eradicate the disease in the hardest-hit West African nations of Guinea, Liberia and Sierra Leone.

This follows a $9 million donation Microsoft co-founder Paul Allen made last month toward the Ebola fight.

The cash infusion couldn’t come at a better time:

* Some 70% of the diagnosed cases thus far have ended in death and the World Health Organization warned in the coming months they could be dealing with 10,000 new cases a week.

“A lot more people will die” if the world doesn’t step up to the plate and deal with the unfolding crisis, Dr. Bruce Aylward of WHO said Tuesday in Geneva.

So far the Ebola death toll stands at 4,447 — nearly all the fatalities in Sierra Leone, Guinea and Liberia.

“The most important step we can take is to stop Ebola at its source,” Tom Frieden, head of the Centers for Disease Control, said. “The sooner the world comes together to help West Africa, the safer we all will be.”

* In Dallas, the first patient in the U.S. to come down with the disease said she was hanging in there.

“I want to thank everyone for their kind wishes and prayers,” Nina Pham said in a statement released by Texas Health Presbyterian Hospital, where she works as a nurse. “I am blessed by the support of family and friends and am blessed to be cared for by the best team of doctors and nurses in the world here.”

Pham, 26, got infected while treating Thomas Duncan, who contracted Ebola in Liberia and died in Dallas last week.

“She is a hero,” said Tom Ha, who attends the same Catholic Church as Pham’s mother. “She knew the patient had Ebola but she treated him like any other patient.”

Pham’s parish priest, the Rev. Jim Khoi of Our Lady of Fatima Church in East Fort Worth, Texas, said he learned from the nurse’s mother that she received a blood transfusion from the nation’s first Ebola survivor, Dr. Kent Brantly.

Ebola is spread by bodily fluids and the CDC suspects Pham caught the bug while she was taking off her protective equipment.

* Frieden said the 48 people Duncan came into contact with before he was hospitalized have “passed the critical period” and have not come down with Ebola.

Translation: they are two-thirds of the way through the 21-day incubation period, which is the riskiest time frame for contracting the disease.

Pham was one of 76 hospital workers who treated Duncan and their health continues to be monitored. Also being checked is a friend of Pham who was in contact with the nurse when she came down with Ebola symptoms.

So far none of them have come down with the disease.

* Frieden said the CDC is now poised to send an “Ebola response team” within hours to any hospital that has a confirmed case. It will include doctors, epidemologists and other specialists.

“I wish we had put a team like this on the ground the day the first patient was diagnosed,” Frieden said of Pham. “That might have prevented this infection.”

* In Leipzig, Germany, a United Nations aid worker died from Ebola infection at St. Georg hospital, a spokesman said Tuesday. The Sudanese man became infected in Liberia and was evacuated to Germany Oct. 9.

The Ebola outbreak was first identified in March and some of the most heroic work has been done by the group Doctors Without Borders.

But it came at a heavy price — the organization reported that 16 of its staffers have been infected with Ebola and nine of them have died.

It has also taken a psychic toll on the doctors trying to stop Ebola from spreading.

“Where is WHO Africa? Where is the African Union?” asked Sharon Ekambaram, who heads DWB in South Africa and worked in Sierra Leone from August to September. “We’ve all heard their promises in the media but have seen very little on the ground.”

Juli Switala, a South African pediatrician with DWB, said at the clinic in Sierra Leone where she worked, they made the conscious decision to not resuscitate babies out of fear that staff may be infected by bodily fluids.

They also had to turn away pregnant women because childbirth posed an even greater risk of exposing the staff to bodily fluids, Switala said.

“The hardest part is that you never get a break from thinking about Ebola,” Switala, who returns to Sierra Leone in a few days.


Original Story: usatoday.com

The Ebola epidemic in West Africa could reach 10,000 cases a week and U.S. health officials are promising dramatic response to any new domestic outbreaks that signal intercontinental spread of the deadly virus.

The Centers for Disease Control will send a rapid response team to any hospital in the nation that diagnoses another Ebola patient, director Tom Frieden said Tuesday.

He voiced regret that the agency had not done so sooner, with the death of the first patient in Dallas last week and the infection of Nina Pham, a young nurse who cared for him.

"That might have prevented this infection," Frieden said. "We should have put an even larger team on the ground immediately, and we will do that any time there is a confirmed case."

Pham, 26, was reported in good condition as a patient at the hospital where she works. She said in a statement from her bed at Texas Health Presbyterian Hospital, "I'm doing well and want to thank everyone for their kind wishes and prayers.''

Her dog, Bentley, a King Charles Spaniel, has been the focus of an outpouring of support as well, particularly after the nation of Spain put to death Excaliber, a pet dog belonging to an infected care nurse there. Dogs may spread the infection, health officials say.

Dallas spokeswoman Sana Syed said Bentley is being monitored and staying in the former residence of the executive officer at a decommissioned military base, Hensley Field, owned by the city. He was moved from Pham's apartment Monday.

"He's wagging his tail, eating, drinking water," Dallas Mayor Mike Rawlings said. "Cute as a button."

Frieden said officials have thus far failed to determine how Pham contracted the virus during treatment of Thomas Eric Duncan, despite using protective clothing and equipment.

The World Health Organization warns that West Africa could see up to 10,000 new cases a week within two months. It said the death rate is now 70% for those infected with Ebola.

WHO assistant director-general Dr. Bruce Aylward provided the grim assesment in Geneva. Previously, the agency had estimated the Ebola mortality rate at around 50 percent overall. By comparison, flu pandemics typically have a death rate under 2 percent.

The organization raised its Ebola death toll tally Tuesday to 4,447 people, nearly all of them in West Africa, out of more than 8,900 believed to be infected.

At the White House, President Obama said that while the U.S. military has made "enormous strides'' in its anti-Ebola mission in West Africa, "The world is not doing enough" to fight Ebola.

"All of us are going to have to do more," Obama said.

Billionaire Mark Zuckerberg, founder of Facebook, said he and his wife will donate $25 million to the Centers for Disease Control Foundation to help fight the spreading infection.

In Dallas, federal and county health staffers are monitoring 76 additional people from the hospital who treated or had some interaction with Duncan. That is in addition to 48 people previously being monitored because of their contacts with Duncan outside the hospital.

Rawlings said the 48 people originally being monitored, including four people living inside the apartment with Duncan, have showed no signs or symptoms of Ebola. Their 21-day incubation period ends Sunday.

"I'm not going to celebrate on the sidelines until then," Rawlings said. "But it is somewhat a relief we've been through that middle week and didn't get any signs. Every day goes by on that is good news."


Original Story: usatoday.com

Every year, 50,000 Americans die from preventable colon cancer. Because of the invasive and uncomfortable nature of the dreaded colonoscopy, it's no surprise only 50% of at-risk individuals actually get screened. Fortunately, advances in medical imaging technology now make screening more comfortable and less expensive.

President Obama himself chose a "virtual colonoscopy" during his first comprehensive exam as commander in chief, but it isn't as widely available as it should be. Misguided certificate-of-need (CON) laws in 36 states restrict access to the procedure recommended by the American College of Radiology.

Initially, the laws were touted as a way to cut health care costs and encourage charity care through centralized planning. In reality, they benefit providers while restricting consumers.

Consider physician Mark Baumel, who wanted to open several medical centers in Virginia to offer virtual colonoscopies.

During the procedure, a CT scanner forms a three-dimensional image of the colon. Because the non-invasive procedure requires no sedation, there's no need for a day off of work for the 80% of patients who test negative. Patients with an abnormality can have their polyps removed on the same day.

Baumel's approach, now used in Delaware, makes screening cheaper, safer and more convenient. But in many states, he cannot offer his approach without battling the CON cartel.

Certificate-of-need laws are essentially a "certificate of monopoly" for established health care businesses. They prohibit new services or, in some states, even new medical equipment without approval. In a lengthy process, medical providers must prove that their proposed medical services are needed. Worse, existing health care facilities are invited to oppose competitors' applications, protecting established businesses from competition.

Defenders of these laws claim they reduce health care costs by avoiding duplication of medical equipment and services, or that they increase charity care.

The reality is that the laws "result in fewer beds and hospitals operating in the typical" metropolitan area, according to the Journal of Health Care Finance. A new study from George Mason University's Mercatus Center finds that the laws restrict access to health care while slowing the adoption of new technology. A review of the economic literature in the study shows that CON laws are likely to result in higher costs and provide no extra services for the indigent.

Ultimately, the most pernicious aspect of CON programs is that they remove the ability of consumers to dictate which medical services are available, turning that power over to regulators and medical providers. That's foolish.

Building a 21st century health care system will take experimentation. The last thing states should do is stand in the way of medical entrepreneurs.


Original Story: usatoday.com

When contagion breaks out — whether it's AIDS in the 1980s, SARS a decade ago or Ebola today — fear invariably spreads faster than the virus.

Vivid imaginations, intense news media coverage, ignorance and natural human fear of the unknown all conspire to defeat reasoned analysis of the facts, which for now at least are these: Only two cases of Ebola have been diagnosed in the USA, one linked to the other and confined to a tiny part of Dallas. Hardly anyone outside the proximity of those two people has any reason for concern, much less panic, until and unless there are more.

Yet the Ebola script is playing out as if it had been written by the authors of Hollywood hits World War Z and Outbreak, or the recent TV drama The Strain.

In Atlanta, fear of the unknown was so thick in August that one pizza driver wouldn't deliver to Emory Hospital, where American Ebola patients brought back from Africa were fighting for their lives inside a special isolation unit. Couriers initially refused to deliver blood test samples to the Centers for Disease Control and Prevention lab a few blocks away. And in Dallas, some residents of the apartment complex where a Liberian man, Thomas Duncan, was visiting family before he died of Ebola were told not to come to work.

Those people, at least, have an excuse. Not so politicians who have been rushing to exploit the crisis for their personal benefit rather than leaning in to help people through it.

The prize so far goes to Louisiana Attorney General Buddy Caldwell, who on Monday got a court order to block the ashes of Duncan's belongings from going to a Louisiana landfill, despite CDC assurances that fire destroys the virus. Caldwell fits a familiar Hollywood stereotype, too: the infuriating character who panics under pressure and endangers everyone else.

Maybe Ebola will be harder to contain here than the nation's leading health officials believe. It's just too early to know for sure. But amid the dreary news Tuesday that the disease is killing 70% of its victims and could produce 10,000 new cases a week by December, there are some striking success stories, even in the African epicenter of the outbreak:

In 2000, Uganda had the worst Ebola outbreak ever until this year. It killed more than 400 people. But that nation has since learned how to contain the disease, and the last three flare-ups have been contained to 18 cases and eight deaths.

Nigeria has managed to stop the spread of Ebola from neighboring countries after a handful of cases turned up there.

And in the middle of hard-hit Liberia, a huge rubber farm reacted so quickly when Ebola struck there that its 80,000 residents are now free of the disease, according to The Wall Street Journal. And that's without the sophisticated medical care available here.

This isn't reason to relax, but it is reason for a calm, deliberate focus on containment — both in Africa, where the U.S. and other nations are belatedly mounting an offensive against the disease, and at home, where the Dallas case has exposed holes in the nation's front-line defenses: emergency rooms and clinics.

The experience so far in Dallas argues for transporting Ebola patients to the four hospitals (in Georgia, Maryland, Nebraska and Montana) specially equipped to handle them. This will work only as long as the number of victims is small, but it could provide breathing room to train hospital staff and ramp up capacity to handle Ebola patients elsewhere.

The needs are more mundane than high-tech: more protective suits, more hands-on training, better protocols for hazardous waste disposal and, with flu season right around the corner, better ways to separate incoming patients.

As for the inclination to panic, the nation would do well to look toward those who have instinctively responded to the crisis with bravery: the medical professionals who have taken mortal risk to fight the contagion in West Africa, the infected nurse in Dallas who risked her life to help Duncan, and leaders such as Dallas County Judge Clay Jenkins, who set a remarkable example for the country by publicly visiting Duncan's quarantined family and fiancée and helping to take them to a new home.

When people complained, medical experts said because the family had exhibited no signs of the disease, what Jenkins did was safe. But it was a display of courage and decency, which is exactly the right antidote for an outbreak of fear.


Original Story: usatoday.com

The fact that Dallas health care worker Nina Pham contracted Ebola even though she wore protective gear while treating Thomas Eric Duncan, the first person diagnosed with the deadly disease in the USA, is spurring demands for better training of health care workers and prompting calls for all U.S. Ebola patients to be cared for at one of the nation's four specially designed hospitals with biocontainment units.

But officials from two of those facilities say the super-hospitals won't be able to handle all future Ebola patients. Every hospital in the USA needs to be prepared to diagnose and treat patients with Ebola, said Bruce Ribner, medical director of the infectious disease unit at Emory University Hospital in Atlanta,which treated the first two Ebola patients in the USA, who contracted the disease in West Africa.

"It's not going to be possible, if this outbreak continues in West Africa, for a select number of institutions to care for patients," Ribner said.

Altogether, those four hospitals can accommodate just 8-13 patients, said Phil Smith, medical director of the biocontainment unit at Nebraska Medical Center in Omaha, which has treated a U.S. missionary and is treating a television news cameraman, both of whom contracted the virus in West Africa. He said Nebraska has 1-2 Ebola beds, Emory 2 beds, St. Patrick Hospital in Montana 1-2 beds and the National Institutes of Health in Maryland 4-7 beds. "But I don't know if they (NIH) have the staffing," he said.

Smith said the U.S. State Department decides which patients get beds at the four biocontainment units.

The nation's largest nurses' organization says most registered nurses at hospitals around the USA have not been given adequate training to handle an Ebola patient. Many hospitals have been slow to provide the proper training because it's expensive, said Charles Idelson, spokesman for National Nurses United, which has 185,000 members.

"Part of the problem with relying on the CDC (Centers for Disease Control and Prevention) is that they don't have an enforcement mechanism," he said. "What we see happening is the CDC can issue a thousand guidelines, but hospitals can choose to follow or not follow whatever guidelines they want. That's been a major roadblock to developing a national coordinated response to Ebola. For weeks, we heard assurances that the hospitals were prepared."

But he says his group's survey of more than 2,100 registered nurses at more than 750 facilities in 46 states and Washington, D.C., found that just 15% had received Ebola education where nurses had the ability to interact and ask questions. "What's happening is they're being given a CDC handout and directed to the CDC's website," he said.

The Society for Healthcare Epidemiology of America, which represents more than 2,000 physicians and other health care professionals, says the current Ebola outbreak "illustrates the need for increased funding for hospital epidemiology and infection prevention programs worldwide. ... The complexity of ensuring 100% adherence to infection control practices, particularly around personal protective equipment (PPE), points to the need for improved training of health care workers across all practice settings."

Pennsylvania Sen. Bob Casey, a Democrat, is calling for additional funding for a hospital preparedness program that has been cut by 50% since 2003. "We have to ensure that hospitals and medical facilities have the resources they need to protect public health," Casey said.

CDC director Thomas Frieden said Monday that the agency will "work with hospitals throughout the country to 'Think Ebola' in someone with a fever or other symptoms who has had travel to any of the three (West African) countries in the previous 21 days."

"We will be looking over the coming days at how we can increase training and increase training materials and availability, most urgently for the health care workers caring for the patient in Dallas, but also more generally throughout our health care system."

It's important for hospitals across the nation to be prepared and equipped to handle a potential Ebola patient because people on flights from Africa can end up in many U.S. cities, Smith said. "Every hospital, even small hospitals, have to have a plan in place to deal with a person who may just show up," he said.

He and other experts say that prepping to treat Ebola patients is costly. "I don't know the cost, except it's going to be expensive," Smith said. "Even for a smaller hospital, you need (an Ebola) dedicated staff, special nurses, a special area with a closed door between the surrounding area. Special security. Special waste handling. Every hospital that commits to prepare is going to have to spend a fair amount of money."

Ambreen Khalil, an infectious disease specialist at Staten Island University Hospital in Staten Island, N.Y., says the hospital is in the process of changing its protocol for removing PPEs. "Our protocols now require someone to observe removal of the equipment," she said. "If you don't peel it off very systematically, like layer by layer, and ensure your skin does not ever make contact with the garment, if you don't do that, you can still get Ebola.

"It is definitely challenging," she said.

Michael Guttenberg, chairman of emergency medicine at Forest Hills Hospital in Forest Hills, N.Y., said the most critical step in preparing for an Ebola patient is having a gatekeeper who can recognize such a person. "They have to have in place a person for identifying people who are potentially at risk," he said. "Essentially, they have to have at the front door a mechanism to identify patients who may be at risk."

In addition, hospitals have to partner with emergency medical services in their community so EMS workers can identify at-risk patients before they arrive at the emergency room. There are additional protocols: ensuring the safety of staff, visitors and patients; setting up an isolation room, and training staff in putting on and taking off the personal protective equipment worn when interacting with an Ebola patient.

Guttenberg said that removing the gear, especially, is a precise, exacting process that can take 6-10 minutes. "If there's any soiling of the outer garment, and if they remove it incorrectly and the outer garment comes into contact with their mucous membranes or their skin, that's where the risk lies for health care workers," he said.

There are protocols for contacting the local health department or the CDC to discuss a potential Ebola patient and determine if the patient is high risk. "If the patient is at high risk, the CDC or health department will ask for certain blood tests," he said. "You hold off on blood work until you talk with the health department or CDC, to limit the amount of needle pricks and possible exposure."

There also are protocols for moving an Ebola patient through the hospital; limiting visitors; cleaning equipment, and properly disposing of dirty linens and body waste.

"Hospitals with good infectious disease control programs in place will find this much easier to accomplish," he said. "A lot of this is just enhancement to what we do fairly routinely."

Guttenberg believes that about 50% of the nation's 4,500-5,000 hospitals are prepared to handle a single Ebola patient. "Very, very few of them could handle multiple patients," he said.

04 November 2014


Original Story: latimes.com

Ending decades of secrecy, Medicare is showing what the giant health care program for seniors pays individual doctors, and some physicians got as much as $10 million in 2012.

The Obama administration is releasing a detailed account Wednesday of $77 billion in payouts to more than 880,000 health care providers nationwide in 2012. The release of payment records involving doctors has been blocked legally since 1979, but recent court rulings removed those obstacles. No personal information on patients is disclosed.

The two highest-paid doctors listed in the Medicare data are already under government review for improper billing. They include an ophthalmologist in the retiree haven of West Palm Beach, Fla., who topped the list by taking in more than $26 million to treat fewer than 900 patients. That is 61 times the average Medicare payout of $430,000 for an ophthalmologist.

A Florida cardiologist received $23 million in Medicare payments in 2012, nearly 80 times the average amount for that specialty. The overwhelming majority of doctors billed the government very modest amounts. Overall, 2 percent of health care providers accounted for 23 percent of these Medicare fees, federal data show.

Medicare officials said disclosing physician payment data marks an unprecedented opportunity to make the nation's health care system more transparent for consumers and accountable to taxpayers. Consumer advocates and employers applauded the move.

"Providing consumers with this information will help them make more informed choices about the care they receive," Jonathan Blum, Medicare's principal deputy administrator, said last week.

Still, federal officials cautioned against drawing sweeping conclusions about individual doctors from the data. They have warned that high payouts are not necessarily indicative of improper billing or fraud. Payments could be driven higher because providers were treating sicker patients who sometimes require more treatment.

These new figures reflect only Medicare Part B claims, which include doctor visits, lab tests and other treatment typically provided outside a hospital. The physician payouts include what Medicare paid plus any money the providers received from patients for deductibles and coinsurance.

Spending on the Medicare program, which covers about 60 million elderly and disabled Americans, is expected to exceed $600 billion this year. There is broad agreement that fraud is rampant in Medicare and Medicaid, the government health program for the poor, but estimates of the scope vary from $20 billion annually to more than $100 billion.

The American Medical Association and other physician groups have long opposed the release of the Medicare data.

AMA President Dr. Ardis Dee Hoven said the group remains concerned that inaccuracies in the data or misinterpretation of the figures may unfairly tar some physicians as outliers.

She said some individual physicians may appear to be billing huge amounts to Medicare, when in fact it is their whole practice that bills under a single physician's name. In other cases, high-volume physicians may actually be experts in their field who will be portrayed in a bad light.

"How does a physician or a practice get their reputation back?" Hoven said. "And even more problematic, what happens to their referral base? What happens to their patients who end up going someplace else?"

For 2012, the top recipient of Medicare money in the country was a Florida ophthalmologist, Dr. Salomon Melgen. Melgen has been a heavy donor to Sen. Robert Menendez, D-N.J. Last year, federal officials said a grand jury was looking into Melgen's billing practices, and a separate investigation was examining whether Menendez had improperly intervened on his behalf.

An attorney for Melgen, Kirk Ogrosky, said the physician has billed at all times in accordance with Medicare rules. Ogrosky said that the vast majority of the money attributed to Melgen reflects the cost of drugs used in treatment and that physician reimbursement is set at 6 percent above what is paid for the medications.

"Dr. Melgen strongly supports transparency in government," said Ogrosky, a former federal prosecutor on health care fraud cases, "but engaging in speculation based on raw data is irresponsible."

Cardiologist Asad Qamar in Ocala, Fla., ranked second nationally with $22.9 million in payments for seeing Medicare patients in 2012. He said specialists like himself who provide a wide variety of services inside their own medical facility have much higher bills because they reflect both the physician's professional fee and other technical fees to cover staffing, medical devices and supplies.

Likewise, some oncologists say their payouts appear so much higher than their peers because they are covering the price of expensive cancer drugs that other doctors operating inside a hospital wouldn't bill for.

"By doing everything in your office, your numbers will be astronomical," Qamar said. "Looking at the sheer volume of payments is a gross mistake."

Qamar said Medicare put his billing on a heightened review and delayed reimbursements more than a year ago.

"I am 100 percent confident we are not doing anything wrong," he said.

Sen. Chuck Grassley, R-Iowa, an advocate for health care transparency, warned that the Obama administration should carefully explain the data. "Transparency isn't just raw data," he said. "It's also making sure the information is in context and makes sense."