Tap tap..is this thing on?

I figured I'd go for one post a decade. A bit late on this one.

I hate it when health care kills people...

...which is why I'm happy when the media do a good job of covering this underappreciated issue. BBC Radio 4 just broadcast an excellent piece on patient safety in the UK. It focuses on alerts issued by the National Patient Safety Agency to local NHS trusts. The alerts are based in part on aggregated reports of errors - or, as some in the US call them, adverse events, to avoid the language of blame - and are meant to help trusts, which have primary responsibility for delivering safe health care, to implement specific procedures aimed at avoiding errors. Trusts are responsible for reporting back on their progress implementing the alerts; there are, evidently, hundreds of trusts that have not yet implemented at least one, and there are a couple more that have not reported back on over 30. A key problem is that there is no national mechanism or authority for enforcing compliance with the alerts, although they are issued at the national level.

The story, about 40 minutes long, did an excellent job of interweaving anecdotes with investigative reporting on NHS policies and procedures. The reporter, Julian O'Halloran, spoke with patients' family members who have now become active in improving patient safety in the UK, as well as policymakers.

One case highlighted was that of a man who was killed by a massive overdose of a painkiller. The media have focused heavily on the fact that the doctor who administered the drug was foreign and had apparently been censured by medical authorities in his home country, that he was unfamiliar with the drug in question, diamorphine, and also that the incident occurred on his first shift working in the UK. What the media have not grasped - until now - was that the drug ampule the doctor used should probably never have been in his medical kit to begin with, because such a high dose has almost no application in day-to-day use. The NPSA had issued guidance in 2006 about safe storage practices for diamorphine, to help clinicians avoid administration errors. O'Halloran spoke to the patient's son, who is himself a doctor, and who mentioned that he had never even seen such a large dose of diamorphine.

Journal Watch, Jan. 13, 2010

Great stuff from the Centre for Evidence-Based Medicine at Oxford, by Dr. Richard Lehman. Now with recipes! Speaking of which, check out my new food blog - in which I figure out how to feed myself in the UK - at Emily Drinking Tea.

FDA acknowledges BPA risks

Seriously, what took them so long? Their reluctance to address due caution to the chemical really presented an impression that the Agency was beholden to chemical industry interests.

Causal language and not just in the headline

A Guardian article on a new epidemiologic study looking at a class of blood pressure drugs and dementia started out with a headline that was doubly misleading:

Blood pressure drugs can halve risk of dementia

First of all, this may just be my own reading problem, but when I first saw the word "halve" my brain saw "have" and interpreted it to mean that the drugs increase risk of dementia. But when I slowed down and re-read it, I was not much happier, because I've developed this intellectual/editorial tic, a tendency to notice and then question statements that imply causation. The Guardian lead reiterated the causal language:

Millions of older people who take drugs for high blood pressure or heart problems can more than halve their risk of developing Alzheimer's disease and dementia, according to research.

For the headline and lead to be supportable, there would have to be a clinical trial randomly assigning people (a lot of them) to get ARB drugs, or not. It seemed unlikely, and in fact, it wasn't the case. Here is the original article from BMJ. Sure enough, right in the article's title, it says that it's a prospective cohort study - a very good one, I'm sure, but designed to look at associations, but not causation. And here's the conclusion of the research article:

Angiotensin receptor blockers are associated with a significant reduction in the incidence and progression of Alzheimer’s disease and dementia compared with angiotensin converting enzyme inhibitors or other cardiovascular drugs in a predominantly male population.

Wordy, but - again - in terms of "association" not an active, causal verb phrase like "cuts risk by half."
Regarding expert comments, I thought the article let the head of research of the Alzheimer's Association get a little carried away with the conclusions of the study: "The prospect of using already existing drugs to help in the fight against dementia is attractive." The head of another Alzheimer's research organization did acknowledge the need for trials to confirm the link.

What color is my what?

The whole Facebook bra-color thing. It started out as a silly meme, someone apparently tried to legitimize it by attaching it to breast cancer awareness, breast cancer groups tried to weigh in, and the Washington Post wrote up the whole kerfuffle.

I think the best thing to come out of the phenomenon, which was over and done with in not much more than 24 hours, was not increased breast cancer awareness - I mean really, aren't we aware enough? - but awareness of and attention to the concept of awareness: What does it mean, where does it get you, and where do we go from here?

Breast cancer awareness needs to go way beyond a mass adolescent giggle about the color of underwear. The timing coincides nicely with the release of Barbara Ehrenreich's new book, a polemic against the feel-good-about-cancer movement. You can read an excerpt of it in the Guardian. She has this to say about awareness:

The first thing I discovered as I waded out into the relevant [breast cancer] sites is that not everyone views the disease with horror and dread. Instead, the appropriate attitude is upbeat and even eagerly acquisitive. There is, I found, a significant market for all things breast cancer-related. You can dress in pink-beribboned sweatshirts, denim shirts, pyjamas, lingerie, aprons, shoelaces and socks; accessorise with pink rhinestone brooches, scarves, caps, earrings and bracelets; and brighten up your home with breast cancer candles, coffee mugs, wind chimes and night-lights. "Awareness" beats secrecy and stigma, of course, but I couldn't help noticing that the existential space in which a friend had earnestly advised me to "confront [my] mortality" bore a striking resemblance to a shopping centre.

A lot of breast-cancer awareness focuses on unproven buddy-check programs and mammography promotion. How about more awareness of what we mostly don't know about breast cancer - what causes it and how to prevent it, not just detect it earlier?

Really?

According to the Washington Post, Maine is considering adding a warning about cancer risk to cell-phones. A state legislator claims that there are "numerous studies" to support such a risk. To be fair, I'm not really current with the literature, but I do wonder: do cell phones also come with a warning about risks of crashing your car?

For that matter, how about absolute risks of cancer, contrasted with absolute risk of crashing your car? Anyone seen these numbers?