Weekly this and that - Nov. 22, 2006

Troops are dying; evidence needed

An off-label use of a hemophilia drug, Factor VII, for stopping bleeding is being used to treat wounded soldiers at the front lines in Iraq, according to the Associated Press, based on a Baltimore Sun article. However, the FDA has warned against its use in non-hemophiliacs, because it has been shown to lead to heart attacks and strokes. The AP article contrasts two sets of anecdotes:

"I've seen it with my own eyes," said Air Force Lt. Col. Jeffrey Bailey, a trauma surgeon deployed this summer as senior physician at the American military hospital in Balad, Iraq. "Patients who are hemorrhaging to death, they get the drug and it stops. Factor VII saves their lives."

However, doctors at military hospitals in Germany and the United States have reported unusual and sometimes fatal blood clots in soldiers evacuated from Iraq, including unexplained strokes, heart attacks and pulmonary embolisms, or blood clots in the lungs. And some have begun to suspect Factor VII, The Sun reported.

It's the representative from Factor VII manufacturer Novo Nordisk who sums up what needs to be done:

"It's really not a question of an absolute safety level, but rather a ratio of benefit to risk that has to be established," said Dr. Michael Shalmi, vice president of biopharmaceuticals for Novo Nordisk.

How are you going to do an adequately controlled randomized trial to answer this question, given the fog of war and all that? Tough problem.

Evidence helps avoid too much health care

A systematic review reported in Reuters Health finds that antibiotics usually don't help against short-term bronchitis, most of which is viral. The study cites the downsides of antibiotic overuse: cost, side effects, and antibiotic resistance.

Patient safety: guidance for hospitals

The Agency for Healthcare Research and Quality last week, at the annual patient safety meeting of the Joint Commission on Accreditation of Hospital Organizations (JCAHO), released a 10-point tip sheet for hospitals on promoting patient safety. The press release is here, and the tip sheet can be found here. It's not a simple checklist of easy things you can do like "Wash your hands" (well, maybe that's not so easy), and most of the tips will require quite a lot of retooling and work to implement, but they're all based on AHRQ's extensive research on hospital patient safety.

Expanding coverage?

The Association of Health Insurance Plans (AHIP) has announced a proposal to expand health insurance coverage to all children within 3 years and to 95% of adults within 10 years, through several strategies:

The plan would expand eligibility for public programs, enable all consumers to purchase health insurance with pre-tax dollars, provide financial assistance to help working families afford coverage, and encourage states to develop and implement access proposals.

As the Workplace Prof Blog points out, the insurance industry does have something to gain, by expanding the number of people who can buy insurance from their kids, but pointed out that the proposal (which I also found sketchy and vague) doesn't say how this plan would be paid for, and how it would take into account increasing health care costs. In any case, it's probably not ready for prime time.