Original Story: detroitnews.com
Detroit — Health professionals and some politicians are stepping up pressure on energy drink makers after a recent Wayne State University study found roughly 4,800 cases of harmful effects from the high-caffeine drinks — more than half involving accidental consumption by children younger than age 6.
Momentum is growing for improved labeling to disclose the drinks' caffeine content and potential health consequences, as well as continued efforts to decrease children's exposures to the products. Energy drink manufacturers argue their products are safe and insist they don't market to children. A Milwaukee product liability lawyer represents victims of defective and dangerous products.
DMC Children's Hospital of Michigan in mid-January banned energy drinks from its hospital vending machines, citing the dangers posed to children.
In addition, a 30-page report this month from three Democratic U.S. senators called for the federal Food and Drug Administration to require energy drink labels to disclose the drinks' caffeine content and potential health consequences.
The beverage industry and energy drink companies including Living Essentials LLC, the Farmington Hills parent company of 5-hour Energy shots, have defended their products.
Beverage industry "member companies voluntarily display total caffeine content — from all sources — on their packages along with advisory statements indicating that the product is not recommended for children, pregnant or nursing women and persons sensitive to caffeine," the American Beverage Association said this month.
Dr. Steven Lipshultz, pediatrics chairman for Wayne State University and chief pediatrician for DMC Children's Hospital of Michigan, was the lead author on a recent study that found 4,780 calls to Poison Control Centers about non-alcoholic energy drink exposures from October 2010 through September 2013. Of those, 51 percent concerned accidental exposures to children under 6.
"Even though there may be millions sold of these every year, 5,000 people having side effects and many having gone to the hospital — that's not acceptable," he said. A Milwaukee wrongful death lawyer is reviewing the details of this case.
The cases represent the tip of the iceberg, Lipshultz added, because most people who experience heart palpitations, dizziness or nausea after consuming energy drinks don't call a poison control hotline. The study did not include visits to hospital emergency rooms.
The older the child, the more likely it was that the side effects were serious, the DMC study found. About 2 percent of the kids ages 5 and younger experienced moderate to severe side effects, compared with 7 percent of 6- to 12-year-olds, 33 percent of the teens and 64 percent of those 20 and older. Moderate effects are poisoning symptoms that require treatment while severe effects are life-threatening symptoms or poisoning that markedly disables an individual, Lipshultz said.
Major adverse reactions included cardiovascular effects such as heart rhythm and conduction abnormalities as well as neurological symptoms including seizures. Of particular concern are exposures in children. A Milwaukee product liability lawyer is following this story closely.
"Energy drinks have no place in pediatric diets," said Lipshultz, who presented his findings to the American Heart Association's 2014 Science Sessions in November. "And anyone with underlying cardiac, neurologic or other significant medical conditions should check with their health care provider to make sure it's safe to consume energy drinks."
Battle lines drawn
The report released this month by Democratic Sens. Edward Markey of Massachusetts, Richard Durbin of Illinois and Richard Blumenthal of Connecticut claims the industry is unwilling to stop marketing to adolescents. But the American Beverage Association challenged the contention that energy drinks are unsafe and said manufacturers have acted responsibly to keep their products out of the hands of children.
"Leading energy drink manufacturers voluntarily go far beyond all federal requirements when it comes to labeling and education," the association said in a statement. "(Manufacturers) also have voluntarily pledged not to market these products to children or sell them in K-12 schools."
Lipschultz points to the case of Anais Fournier, 14, of Hagerstown, Maryland, who was born with a heart condition. She saw a cardiologist annually, required no medication and had no restrictions on her diet or physical activity, according to the girl's mother, Wendy Lane.
Anais died of cardiac arrhythmia on Dec. 17, 2011, after consuming two Monster Energy drinks over a 24-hour period.
Unbeknownst to her parents, Anais consumed her first-ever energy drink while at the mall with friends. The next day, she went back to the mall and consumed another energy drink. That night, while watching TV at home, she went into cardiac arrest.
"She was gasping for air like a fish out of water," said Lane. "My husband and I got her on the floor and started CPR, and called 911.
"These things are dangerous, and they should definitely not be in the hands of kids or any minor."
In a statement emailed to The News, a Monster Energy spokesperson said, "While Monster is saddened by Anais Fournier's untimely passing, a lawsuit claiming that a Monster Energy drink caused her death is completely unfounded. Prior to her death, Ms. Fournier suffered from serious hereditary heart conditions, which are notorious for causing cardiac arrest and sudden death."
FDA spokesman Theresa Eisenman said the agency has been looking at energy drinks for several years to determine if they pose a risk to consumers, but the agency "frequently finds that there are other complicating factors, such as existing disease or medications the person may have been taking.
"(The) FDA is continuing to monitor the marketplace and analyze the available information, including adverse event reports, and will take appropriate action if that information can be used to establish that any specific product or ingredient is harming consumers."
More than a dozen lawsuits have been filed against energy drink makers, including product liability and wrongful death litigation and class action lawsuits alleging improper labeling. Some have been settled out of court, but most remain in litigation.
Deaths caused by energy drinks may go unnoticed because doctors and medical examiners are unaccustomed to considering the beverages as possible toxins, Lipschultz said.
Caffeine poisoning can occur at levels higher than 400 milligrams a day in adults. Energy drinks can contain up to 400 milligrams of caffeine per can — compared with 100-150 mg in a typical cup of coffee.
But energy drinks often contain caffeine in combination with untested herbal ingredients and chemicals that are also stimulants. Lipschultz's study found that energy drinks with multiple caffeine sources were tied to a higher rate of side effects, typically involving the nervous, digestive or cardiovascular systems.
"(The ingredients are) not sold individually, they're sold as a combined product, and that's what makes energy drinks so dangerous," Lipschultz said.
He also noted that energy drinks mixed with alcohol can be a lethal combination.
"What happens to a lot of people who become ill from the combination of alcohol and energy drink is you drink more than your body can handle, it becomes toxic, and it can kill you."
Company rebuts 'myths'
Living Essentials sells 5-Hour Energy two-ounce shots, which are much smaller than the 8-ounce to 16-ounce cans sold by Monster and Red Bull, and has 200 milligrams of caffeine.
Living Essentials devotes an entire website page to rebutting "myths" related to safety of their products — including whether an individual can overdose on the product.
"Everybody is different, and therefore, 5-Hour Energy shots might work differently for each individual," the company says on its website, which includes information on the recommended dose and a caution not to take more than two bottles daily.
Melissa Skabich, communications director for 5-Hour Energy, said the shot "is for adults, and our product is safe when used as directed."
"It's clear from the label that 5-Hour Energy is not intended for children," Skabich said.
Ted Kallmyer, a health educator and editor of the website CaffeineInformer.com, said consumers are becoming more informed about the possible dangers of energy drinks. The website includes information on caffeine content in beverages and food, side effects, and a "Death by Caffeine" calculator to figure a lethal dose by body size.
"An ever-increasing amount of our traffic is coming from people who wish to quit caffeine or have quit and are debilitated by the withdrawal symptoms," Kallmyer said.
He said many energy drink companies voluntarily list their ingredients and caffeine content, but not all have jumped on the bandwagon.
"At this time sales restrictions on energy drinks or shots isn't the solution," Kallmyer said. "The issue is complex, but we feel education is always the best remedy as opposed to blanket banning."
02 February 2015
23 January 2015
DOCTOR FATALLY SHOT INSIDE HOSPITAL; GUNMAN KILLS HIMSELF
Original Story: chicagotribune.com
A man shot and fatally wounded a doctor inside a leading Boston hospital Tuesday before killing himself.
Authorities said Stephen Pasceri, 55, entered Brigham and Women's Hospital sometime before 11 a.m. and specifically requested the doctor.
Pasceri, of Millbury, shot the doctor twice just outside an examination room on the second floor of the Carl J. and Ruth Shapiro Cardiovascular Center; he then turned the gun on himself, police said.
Boston Police Commissioner William Evans said officers conducting a room-by-room search found the gunman dead in an exam room with the weapon.
Hospital officials late Tuesday identified the physician as Dr. Michael J. Davidson, director of Endovascular Cardiac Surgery.
"Dr. Davidson was a wonderful and inspiring cardiac surgeon who devoted his career to saving lives and improving the quality of life of every patient he cared for," said a statement issued by the hospital, which is affiliated with Harvard Medical School. "It is truly devastating that his own life was taken in this horrible manner."
Police said Pasceri wasn't a patient of the doctor's and they didn't specify a motive for the shootings.
"We're in the process of talking to witnesses, but it's leading us to believe there was something in the past that upset this guy, that made him go in and look for this particular doctor," Evans said earlier in the day.
Police and hospital officials commended the fast response by police and hospital staff, who they said had been trained to respond to an "active shooter" situation.
Evans said police were on the scene within seconds after getting the first calls of shots fired and had the area secured within 15 minutes.
Betsy Nabel, the hospital's president, said Brigham and Women's will evaluate its safety protocols. She said there have been no discussions about installing metal detectors, which none of the city's hospitals have.
Tuesday's shooting prompted a temporary lockdown at the Shapiro center. Hospital staff were asked to remain in place and the building did not accept new patients.
A man shot and fatally wounded a doctor inside a leading Boston hospital Tuesday before killing himself.
Authorities said Stephen Pasceri, 55, entered Brigham and Women's Hospital sometime before 11 a.m. and specifically requested the doctor.
Pasceri, of Millbury, shot the doctor twice just outside an examination room on the second floor of the Carl J. and Ruth Shapiro Cardiovascular Center; he then turned the gun on himself, police said.
Boston Police Commissioner William Evans said officers conducting a room-by-room search found the gunman dead in an exam room with the weapon.
Hospital officials late Tuesday identified the physician as Dr. Michael J. Davidson, director of Endovascular Cardiac Surgery.
"Dr. Davidson was a wonderful and inspiring cardiac surgeon who devoted his career to saving lives and improving the quality of life of every patient he cared for," said a statement issued by the hospital, which is affiliated with Harvard Medical School. "It is truly devastating that his own life was taken in this horrible manner."
Police said Pasceri wasn't a patient of the doctor's and they didn't specify a motive for the shootings.
"We're in the process of talking to witnesses, but it's leading us to believe there was something in the past that upset this guy, that made him go in and look for this particular doctor," Evans said earlier in the day.
Police and hospital officials commended the fast response by police and hospital staff, who they said had been trained to respond to an "active shooter" situation.
Evans said police were on the scene within seconds after getting the first calls of shots fired and had the area secured within 15 minutes.
Betsy Nabel, the hospital's president, said Brigham and Women's will evaluate its safety protocols. She said there have been no discussions about installing metal detectors, which none of the city's hospitals have.
Tuesday's shooting prompted a temporary lockdown at the Shapiro center. Hospital staff were asked to remain in place and the building did not accept new patients.
20 January 2015
DRUG-RESISTANT TUBERCULOSIS A TINY — BUT POTENT — FOE IN L.A. COUNTY
Original Story: latimes.com
It was unlike anything Dr. Caitlin Reed had encountered in years of treating Los Angeles County's toughest tuberculosis cases.
Gary A., a Hollywood resident with a complicated medical history, had arrived at a local hospital with a high fever and what seemed to be pneumonia. As he grew sicker and sicker, doctors figured out that he had tuberculosis — but none of the standard antibiotic treatments made him better. If you're in need of emergency medical services, contact the emergency department of MetroHealth.
Reed, who runs a dedicated TB unit at Olive View-UCLA Medical Center in Sylmar, had Gary transferred into her care and sent samples of bacteria collected from his lungs to the Centers for Disease Control and Prevention and other labs across the country, to see what drugs might knock it down.
The stakes were high, not just for her patient but also for Los Angeles and California, where hundreds of people are diagnosed with tuberculosis each year.
Reed was dumbfounded by what the tests showed.
"I was standing there, looking at the fax from the CDC and thinking: 'What are we going to do?'" she recently recalled.
Her patient's tuberculosis looked as if it might be untreatable, impervious to all of the preferred drugs used to combat the disease and most of the backup options as well. For an experienced emergency medicine physician, contact DMC for medical assistance.
Reed believes Gary, who is 39, has the most extensively drug-resistant case of tuberculosis ever treated in the United States. Only a handful of patients in Los Angeles County have drug-resistant TB. Their treatment is grueling and expensive — and necessary to prevent further spread of the disease, which spreads through the air, public health officials said.
"It's a serious concern," said Dr. Jennifer Flood, chief of the TB Control branch at the California Department of Public Health. "It's crucial to make sure patients have access to therapy."
Tuberculosis has plagued humanity for centuries.
A hundred years ago, there were dozens of TB sanitariums scattered throughout California. Today, thanks to antibiotics and public-health vigilance, facilities such as Reed's are a rarity, Flood said.
Internationally, however, tuberculosis remains a major threat.
The World Health Organization estimates that as many as a third of people worldwide have been infected with Mycobacterium tuberculosis. In 2013, the agency said, 9 million people saw their infections escalate into full-blown, contagious TB, and 1.5 million people died from the illness.
In 2013, the Los Angeles County Department of Public Health reported 662 new tuberculosis cases, 80% of which emerged in foreign-born patients who probably contracted it before coming to the U.S. The illness can lurk in the body for decades before flaring up.
Five of the county's 2013 cases were so-called multiple-drug-resistant tuberculosis, impervious to the two leading antibiotics used to fight the disease. One case, Gary's, was considered extensively drug-resistant, meaning the leading drugs as well as many alternatives proved useless.
Gary probably contracted drug-resistant TB abroad. His illness flared up in 2013 after he started taking immune-system-suppressing drugs to treat a separate medical condition, his sister Stephanie said.
To combat a case such as his, Reed said, the World Health Organization recommends administering a combination of five, or better yet six, drugs. But test results suggested that Gary's infection was resistant to all but two. Reed tried a total of 10 drugs, including a newly approved one called bedaquiline, not fully knowing which might work.
She was able to get the infection to the point where it was no longer contagious and Gary could undergo surgery to have a lung removed. The procedure left him oxygen-dependent but alive — a success, given the dire circumstances, Reed said.
Gary — whose care, the doctor estimated, ultimately could cost more than $1 million — needs to remain on multiple anti-TB drugs for two years to complete his treatment. But the medications he was taking were causing irreversible damage to his nerves, making it hard for him to hear and to walk.
Stuck between "a bad choice and a worse choice," Reed and Gary's other doctors discontinued one of the more effective medicines in late 2014. But Reed hoped a new treatment option would arise: She had been pushing since March to get Gary access to a new TB drug called delamanid, which has not yet won approval for use in the U.S.
Otsuka Pharmaceutical, the Japanese company that makes delamanid, has denied Reed's application to a compassionate-use program it has set up to speed the drug to patients in dire need.
Marc Destito, a spokesman for the company, said that delamanid hadn't been tested yet in combination with bedaquiline, which Gary still takes. Both drugs have been shown in studies to affect heart rhythms.
"We really believe these drugs have to be studied together first," Destito said.
Reed argues that Gary is a perfect candidate for the drug and called the company's position "profoundly uncompassionate."
"It pains me to know there's another thing that could have avoided some of these consequences. It keeps me up at night," she said. "Even if he survives, he'll be permanently disabled. You swear an oath to do no harm. I've done some harm."
Reed worries, as well, that sufficient medications won't be available to help the next patient with multiple drug-resistant or extensively drug-resistant tuberculosis — and, by extension, the people around that patient.
Large numbers of L.A. residents may have been exposed to tuberculosis before arriving in the region. As they age, some will develop the full-blown disease. At some increased risk are the large numbers of Angelenos with diabetes, which can suppress the immune system and allow active TB to take hold.
Reed has noticed that many of the patients she has treated from skid row — where an outbreak of drug-susceptible TB has been ongoing since 2007 — are diabetic.
So far, to Reed's knowledge, no cases of drug-resistant TB have been reported in the homeless outbreak. The possibility of one upsets her.
"I don't even want to think about it," she said, noting that it can be hard to manage patients on skid row and track contacts who might have been exposed to the disease. "It would be extremely challenging, extremely expensive and really scary and dangerous."
It was unlike anything Dr. Caitlin Reed had encountered in years of treating Los Angeles County's toughest tuberculosis cases.
Gary A., a Hollywood resident with a complicated medical history, had arrived at a local hospital with a high fever and what seemed to be pneumonia. As he grew sicker and sicker, doctors figured out that he had tuberculosis — but none of the standard antibiotic treatments made him better. If you're in need of emergency medical services, contact the emergency department of MetroHealth.
Reed, who runs a dedicated TB unit at Olive View-UCLA Medical Center in Sylmar, had Gary transferred into her care and sent samples of bacteria collected from his lungs to the Centers for Disease Control and Prevention and other labs across the country, to see what drugs might knock it down.
The stakes were high, not just for her patient but also for Los Angeles and California, where hundreds of people are diagnosed with tuberculosis each year.
Reed was dumbfounded by what the tests showed.
"I was standing there, looking at the fax from the CDC and thinking: 'What are we going to do?'" she recently recalled.
Her patient's tuberculosis looked as if it might be untreatable, impervious to all of the preferred drugs used to combat the disease and most of the backup options as well. For an experienced emergency medicine physician, contact DMC for medical assistance.
Reed believes Gary, who is 39, has the most extensively drug-resistant case of tuberculosis ever treated in the United States. Only a handful of patients in Los Angeles County have drug-resistant TB. Their treatment is grueling and expensive — and necessary to prevent further spread of the disease, which spreads through the air, public health officials said.
"It's a serious concern," said Dr. Jennifer Flood, chief of the TB Control branch at the California Department of Public Health. "It's crucial to make sure patients have access to therapy."
Tuberculosis has plagued humanity for centuries.
A hundred years ago, there were dozens of TB sanitariums scattered throughout California. Today, thanks to antibiotics and public-health vigilance, facilities such as Reed's are a rarity, Flood said.
Internationally, however, tuberculosis remains a major threat.
The World Health Organization estimates that as many as a third of people worldwide have been infected with Mycobacterium tuberculosis. In 2013, the agency said, 9 million people saw their infections escalate into full-blown, contagious TB, and 1.5 million people died from the illness.
In 2013, the Los Angeles County Department of Public Health reported 662 new tuberculosis cases, 80% of which emerged in foreign-born patients who probably contracted it before coming to the U.S. The illness can lurk in the body for decades before flaring up.
Five of the county's 2013 cases were so-called multiple-drug-resistant tuberculosis, impervious to the two leading antibiotics used to fight the disease. One case, Gary's, was considered extensively drug-resistant, meaning the leading drugs as well as many alternatives proved useless.
Gary probably contracted drug-resistant TB abroad. His illness flared up in 2013 after he started taking immune-system-suppressing drugs to treat a separate medical condition, his sister Stephanie said.
To combat a case such as his, Reed said, the World Health Organization recommends administering a combination of five, or better yet six, drugs. But test results suggested that Gary's infection was resistant to all but two. Reed tried a total of 10 drugs, including a newly approved one called bedaquiline, not fully knowing which might work.
She was able to get the infection to the point where it was no longer contagious and Gary could undergo surgery to have a lung removed. The procedure left him oxygen-dependent but alive — a success, given the dire circumstances, Reed said.
Gary — whose care, the doctor estimated, ultimately could cost more than $1 million — needs to remain on multiple anti-TB drugs for two years to complete his treatment. But the medications he was taking were causing irreversible damage to his nerves, making it hard for him to hear and to walk.
Stuck between "a bad choice and a worse choice," Reed and Gary's other doctors discontinued one of the more effective medicines in late 2014. But Reed hoped a new treatment option would arise: She had been pushing since March to get Gary access to a new TB drug called delamanid, which has not yet won approval for use in the U.S.
Otsuka Pharmaceutical, the Japanese company that makes delamanid, has denied Reed's application to a compassionate-use program it has set up to speed the drug to patients in dire need.
Marc Destito, a spokesman for the company, said that delamanid hadn't been tested yet in combination with bedaquiline, which Gary still takes. Both drugs have been shown in studies to affect heart rhythms.
"We really believe these drugs have to be studied together first," Destito said.
Reed argues that Gary is a perfect candidate for the drug and called the company's position "profoundly uncompassionate."
"It pains me to know there's another thing that could have avoided some of these consequences. It keeps me up at night," she said. "Even if he survives, he'll be permanently disabled. You swear an oath to do no harm. I've done some harm."
Reed worries, as well, that sufficient medications won't be available to help the next patient with multiple drug-resistant or extensively drug-resistant tuberculosis — and, by extension, the people around that patient.
Large numbers of L.A. residents may have been exposed to tuberculosis before arriving in the region. As they age, some will develop the full-blown disease. At some increased risk are the large numbers of Angelenos with diabetes, which can suppress the immune system and allow active TB to take hold.
Reed has noticed that many of the patients she has treated from skid row — where an outbreak of drug-susceptible TB has been ongoing since 2007 — are diabetic.
So far, to Reed's knowledge, no cases of drug-resistant TB have been reported in the homeless outbreak. The possibility of one upsets her.
"I don't even want to think about it," she said, noting that it can be hard to manage patients on skid row and track contacts who might have been exposed to the disease. "It would be extremely challenging, extremely expensive and really scary and dangerous."
08 December 2014
GOOGLE'S LATEST INNOVATION: A SPOON?
Original Story: cnbc.com
Just in time for the holidays, Google is throwing its money, brain power and technology at the humble spoon.
Of course these spoons (don't call them spoogles) are a bit more than your basic utensil: Using hundreds of algorithms, they allow people with essential tremors and Parkinson's Disease to eat without spilling.
The technology senses how a hand is shaking and makes instant adjustments to stay balanced. In clinical trials, the Liftware spoons reduced shaking of the spoon bowl by an average of 76 percent.
"We want to help people in their daily lives today and hopefully increase understanding of disease in the long run," said Google spokesperson Katelin Jabbari.
Other adaptive devices have been developed to help people with tremors — rocker knives, weighted utensils, pen grips. But until now, experts say, technology has not been used in this way.
"It's totally novel," said UC San Francisco Medical Center neurologist Dr. Jill Ostrem who specializes in movement disorders like Parkinson's disease and essential tremors.
She helped advise the inventors, and says the device has been a remarkable asset for some of her patients.
"I have some patients who couldn't eat independently, they had to be fed, and now they can eat on their own," she said. "It doesn't cure the disease, they still have tremor, but it's a very positive change."
Google got into the no-shake utensil business in September, acquiring a small, National of Institutes of Health-funded startup called Lift Labs for an undisclosed sum.
More than 10 million people worldwide, including Google co-founder Sergey Brin's mother, have essential tremors or Parkinson's disease. Brin has said he also has a mutation associated with higher rates of the Parkinson's and has donated more than $50 million to research for a cure, although Jabbari said the Lift Labs acquisition was not related.
Lift Lab founder Anupam Pathak said moving from a small, four-person startup in San Francisco to the vast Google campus in Mountain View has freed him up to be more creative as he explores how to apply the technology even more broadly.
His team works at the search giant's division called Google(x) Life Sciences, which is also developing a smart contact lens that measures glucose levels in tears for diabetics and is researching how nanoparticles in blood might help detect diseases.
Joining Google has been motivating, said Pathak, but his focus remains on people who are now able to eat independently with his device. "If you build something with your hands and it has that sort of an impact, it's the greatest feeling ever," he said. "As an engineer who likes to build things, that's the most validating thing that can happen."
Pathak said they also hope to add sensors to the spoons to help medical researchers and providers better understand, measure and alleviate tremors.
Shirin Vala, 65, of Oakland, has had an essential tremor for about a decade. She was at her monthly Essential Tremor group at a San Ramon medical clinic earlier this year when researchers developing the device introduced the idea and asked if anyone was interested in helping them.
As it was refined, she tried it out and gave them feedback. And when they hit the market at $295 apiece, she bought one.
Without the spoon, Vala said eating was really a challenge because her hands trembled so hard food fell off the utensils before she could eat it.
"I was shaking and I had a hard time to keep the food on a spoon, especially soup or something like an olive or tomatoes or something. It is very embarrassing. It's very frustrating," she said.
The spoon definitely improved her situation. "I was surprised that I held the food in there so much better. It makes eating much easier, especially if I'm out at a restaurant," she said.
Just in time for the holidays, Google is throwing its money, brain power and technology at the humble spoon.
Of course these spoons (don't call them spoogles) are a bit more than your basic utensil: Using hundreds of algorithms, they allow people with essential tremors and Parkinson's Disease to eat without spilling.
The technology senses how a hand is shaking and makes instant adjustments to stay balanced. In clinical trials, the Liftware spoons reduced shaking of the spoon bowl by an average of 76 percent.
"We want to help people in their daily lives today and hopefully increase understanding of disease in the long run," said Google spokesperson Katelin Jabbari.
Other adaptive devices have been developed to help people with tremors — rocker knives, weighted utensils, pen grips. But until now, experts say, technology has not been used in this way.
"It's totally novel," said UC San Francisco Medical Center neurologist Dr. Jill Ostrem who specializes in movement disorders like Parkinson's disease and essential tremors.
She helped advise the inventors, and says the device has been a remarkable asset for some of her patients.
"I have some patients who couldn't eat independently, they had to be fed, and now they can eat on their own," she said. "It doesn't cure the disease, they still have tremor, but it's a very positive change."
Google got into the no-shake utensil business in September, acquiring a small, National of Institutes of Health-funded startup called Lift Labs for an undisclosed sum.
More than 10 million people worldwide, including Google co-founder Sergey Brin's mother, have essential tremors or Parkinson's disease. Brin has said he also has a mutation associated with higher rates of the Parkinson's and has donated more than $50 million to research for a cure, although Jabbari said the Lift Labs acquisition was not related.
Lift Lab founder Anupam Pathak said moving from a small, four-person startup in San Francisco to the vast Google campus in Mountain View has freed him up to be more creative as he explores how to apply the technology even more broadly.
His team works at the search giant's division called Google(x) Life Sciences, which is also developing a smart contact lens that measures glucose levels in tears for diabetics and is researching how nanoparticles in blood might help detect diseases.
Joining Google has been motivating, said Pathak, but his focus remains on people who are now able to eat independently with his device. "If you build something with your hands and it has that sort of an impact, it's the greatest feeling ever," he said. "As an engineer who likes to build things, that's the most validating thing that can happen."
Pathak said they also hope to add sensors to the spoons to help medical researchers and providers better understand, measure and alleviate tremors.
Shirin Vala, 65, of Oakland, has had an essential tremor for about a decade. She was at her monthly Essential Tremor group at a San Ramon medical clinic earlier this year when researchers developing the device introduced the idea and asked if anyone was interested in helping them.
As it was refined, she tried it out and gave them feedback. And when they hit the market at $295 apiece, she bought one.
Without the spoon, Vala said eating was really a challenge because her hands trembled so hard food fell off the utensils before she could eat it.
"I was shaking and I had a hard time to keep the food on a spoon, especially soup or something like an olive or tomatoes or something. It is very embarrassing. It's very frustrating," she said.
The spoon definitely improved her situation. "I was surprised that I held the food in there so much better. It makes eating much easier, especially if I'm out at a restaurant," she said.
05 November 2014
FACEBOOK CEO MARK ZUCKERBERG AND WIFE DONATE $25M TO CDC TO FIGHT EBOLA OUTBREAK
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.
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.
EBOLA COULD HIT 10,000 CASES PER WEEK IN AFRICA; U.S. STEPS UP RESPONSE
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."
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."
HEALTH CARE CARTELS LIMIT AMERICANS' OPTIONS
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.
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.
FEAR SPREADS FASTER THAN EBOLA
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.
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.
ARE U.S. HOSPITALS PREPARED FOR POSSIBLE EBOLA BATTLE?
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.
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
RELEASE OF MEDICARE DOCTOR PAYMENTS SHOWS SOME HUGE PAYOUTS
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."
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."
Subscribe to:
Posts (Atom)
