Aviation safety revisited

An article from today's New York Times describes a 65% drop in plane-crash fatalities over 10 years, accomplished in large part by identifying seemingly small problems that often precede crashes. Now that there are so few crashes, and data are sparse, the industry has reversed its learning patterns and analyzes flights that go well.

Apparently aviation is learning from its mistakes. Can hospitals - where, in an era of tens of thousands of deaths due to errors per year, data are not sparse - do the same?

Polypharmacy awareness

The New York Times today had an article by Jane Brody describing the phenomenon of polypharmacy: simply put, too many drugs, whether prescription, over-the-counter, or both. It's a particular problem in elderly patients, who suffer from multiple conditions, and who often see multiple doctors who don't know what other drugs patients are taking. Those drugs often interact, producing additional morbidity and even death.

Here are some sobering data describing the incidence of polypharmacy:

Polypharmacy is responsible for up to 28 percent of hospital admissions and, he added, if it were classified as such, it would be the fifth leading cause of death in the United States.

Polypharmacy can even occur when doctors do know what other doctors have prescribed, but are afraid to override other doctors' decisions. There's an increasingly useful role for consultant pharmacists, who, despite their superior training in identifying potential interactions, often come into conflict with physicians when they question prescriptions.

I'm glad, however, that the term "polypharmacy" is now out there in the New York Times. Increased awareness of polypharmacy is one way in which patients and their families can be better advocates for their own care. Changing the culture of medicine and reducing the fragmentation of health care to reduce risk of polypharmacy are, again, as we all know, different stories entirely.

Massachusetts moves toward transparency on health care costs

The California Health Care Foundation's ihealthbeat online newsletter today reported that Massachusetts plans to post payment data on hospitals online, based on a recent Boston Globe article. Specifically, each hospital will be required to post average payments made by each insurer for certain procedures, the idea being to allow consumers to comparison-shop for hospitals on the basis of costs. Hospitals will also post quality information on these procedures, but the specific procedures have not yet been decided upon.

New Hampshire has posted payment data, but not quality data, on a range of types of hospitalizations, some of which may be more feasible than others for comparison shopping.

Best science/politics article of the week

President Bush, something of an "armchair physicist," discovered an error in a particle-physics article from Fermilab, and modestly described the error to scientists at the lab and to the press.

Thanks, Onion!

Senate passes mental health parity bill

New legislation passed today by the U.S. Senate will ensure that all health insurance plans cover mental health care at the same level as coverage for general health issues.

This reform is long overdue. From my own perspective, I recently picked up temporary health coverage with a modest premium of about $230 per month, and noticed when I got the paperwork that it didn't include a mental health rider. When I inquired about the cost with the mental health coverage, I was told my monthly premium would be on the order of $800 per month. So I skipped it, and prayed for mental fortitude, though as far as I know, prayer is not an evidence-based preventive intervention against mental illness.

Pearlstein on Clinton's health care proposal

Steve Pearlstein of the Washington Post writes today that Hillary Clinton's new plan, announced this week, is the best among those of the Democratic candidates. Of all, the candidates, in fact; Pearlstein says about the Republicans,

The knee-jerk response from Republicans was to smear her proposal as "socialized medicine," a fresh reminder of how illiterate, out-of-touch and irrelevant the Republicans have become on the most important domestic issue to voters.

Hey, he said it, I didn't.

Pearlstein cautions that Clinton has a lot of political work and voter education to do to sell the crucial nuances and inevitable tradeoffs of her proposal. Where I would start is by stressing that rationing is not necessarily a bad word; it doesn't have to be about profits for the insurance industry (though under Clinton's plan that will likely be the reality, at least in part), and it could actually improve health care both for individuals (by limiting the use of unproven, potentially risky procedures) and certainly for the population as a whole (by allowing more equitable distribution of resources). I'd like to see more details on modernizing Medicare in this regard.

But how can we get Americans with good health coverage to see that they may not need everything that they're currently consuming?

Free online evidence-based health care course

The U.S. Cochrane Center at Johns Hopkins University's Bloomberg School of Public Health is offering a free online course in evidence-based health care. It's designed for consumers and consumer advocates who need to be able to distinguish high-quality research evidence from evidence that's not so reliable. The U.S. Cochrane Center is part of the worldwide Collaboration, comprising some of the world's gurus on evidence based medicine, and the course is taught by breast-cancer survivor and patient advocate Musa Mayer, and was co-developed by Kay Dickersin, Cochrane Center director.

A little quiz: I've attached the nifty logo of the Cochrane Collaboration. Would anyone care to describe what it represents? (Epidemiologists should hold back, at least for now.)

evidence-based medicine

Getting health care priorities in order

Shannon Brownlee, whom I interviewed on this blog a few months ago, has an article in the new Washington Monthly on why we need to fully fund AHRQ (the Agency for Healthcare Research and Quality - remember it!), and all the reasons why it's important to insist on evidence in health care.

Bee science

Researchers finally have a clue about the mass disappearance of pollinating honeybees from hives across the country and elsewhere, as reported in today's NYTimes: a virus, the presence of which was 62 times more likely in hives that had collapsed than in those that had not. Because the very strong association could still be a coincidence, however,

To try to clarify cause and effect, the researchers said they were preparing a new suite of tests in which isolated bee colonies would be intentionally infected with the virus, both with and without possible secondary causes like certain parasites.

I guess you could call it epiapiology (to mix Latin and Greek)...

Immigrants and mental health

Just read this chat on washingtonpost.com about access to mental health among immigrants to the U.S., with Dr. Hochang Benjamin Lee of Johns Hopkins. Here's a related article from earlier in the week, which suggests (without a lot of hard data) that immigrant parents are likely to be in denial about their children's mental illness, among other barriers. Both of these are apropos of this week's state of Virginia report on the mental health of Seung Hui Cho, the Virginia Tech student who killed 32 people and then himself.