With the new hand burn phenomena raising eyebrows, an investigation was launched on the gloves.  Much to everyone’s surprise, it turned out that one of the materials in the gloves inner lining was changed.  In other words, while the Blaze Fighter glove passed the National Fire Protection Association standards when the insides consisted of cotton fiber, the gloves were then produced with a polyester blend, which was cheaper for production and inevitably more dangerous.  As reported on the Uniformed Firefighters Association’s website and Firefighters Close Calls, subsequent testing revealed that the back of the gloves no longer met the minimum performance requirement.

The gloves, which are being  used by 6,500 New York firefighters, were originally selected after successfully completing a trial run.  Initially, fireman favored the gloves because they were thinner and provided more dexterity than their old gloves. However, it appears that the change in material was made without notification to the FDNY.

While the material switch has prompted an investigation and raised questions about whether or not the FDNY will file suit against Glove Corp to reclaim the $850,000 they spent on the gloves, Glove Corp, whose manufactured firefighting gloves for over 30 years,  has not hesitated to make a move of their own.   Shortly after releasing a safety notice on  January 14, 2011, the company shut down business.

*For additional coverage, read the New York Time’s article published by Al Baker.

Despite the Roe v. Wade 1973 Supreme Court decision deeming abortions legal in the United States, health professionals are starting to pick up on a trend seen in other countries where abortions are illegal— taking “the little white pills”, known as misoprostol to terminate their pregnancy.

While health care professionals know that women are obtaining the drug on the “black market”, they have no clue how often it’s happening, raising concern.  “It’s a hot topic, but there’s little data,” says Dr. Dave Turok, assistant professor of Obstetrics-Gynecology at the University of Utah.

Misoprostol, also known by it’s brand name Cytotec, is a drug that was approved by the Food and Drug Administration for the treatment of ulcers, but has become widely used off label for medical abortions and induction of labor.  Medical abortions in the U.S. are done using a combination of mifepristone and misoprostol, but women getting misoprostol through back stage bodegas or friends are taking it without the recommended mifepristone dose.  Yamila Azize-Vargas, researcher at the University of Puerto Rico’s School of Medicine says, “It is one of the most clandestine types of abortions you can have.”

After approval of Cytotec in 1988, a black box warning was put on the bottle, indicating that administering the drug to pregnant women can cause abortion. It has been used in the underground market ever since.  However, women taking the pills outside of a medical setting may be unaware of the risk of heavy bleeding or pain.  “If you’re at home and no one knows you’re doing this you can get in trouble with heavy bleeding and not have a way to get to medical care.,” says Dr. Turok. “That could be dangerous.”

Use of misprostol often leads to lower abdominal pain, cramping and nausea.  While women in medical settings are provided with narcotic pain medicine, women who are self-inducing may not have access to these medications making their experience more unpleasant.

Women using this method are also learning that taking misoprostol is not 100% guaranteed to work.   According to Gynuity, an international reproductive health agency, use of misoprostol in pregnancy termination fails 10-15% of the time.

For a woman visiting her clinic in the Bronx this situation was all too familiar.  Not convinced that she had successfully aborted, the women visited her doctor and learned that her attempt to terminate her pregnancy failed.  In this case, the decision to take misoprostol was made in the hopes of keeping the abortion simple and private.  Her physician, who asks to remain anonymous in order to protect herself, her patients and the institution where she works, agrees saying, “What we’re doing should be confidential.” While this young woman was able to undergo an abortion in her doctor’s office, others who carry to term after failing to abort have reported cases of babies born without fingers, abnormalities in the limbs and damage to their central nervous system.

If taken after nine weeks of pregnancy, women run the risk of heavier bleeding, or as was the case for a 18-year-old Dominican immigrant living in Boston, self-inducing labor instead of a miscarriage.  Not knowing her options she consequently delivered a live one-pound baby, which died four days later.  Says Dr. Turok, “People incorrectly estimate how far along they are in pregnancy all the time.”

With the right connections, doctors are discovering that misoprostol can be bought at local bodegas or in some cases at independent pharmacies for as little as $10 a pill.  “But you need to know someone,” says the physician from the Bronx.  “You need a password to get in.”

Buying drugs in different countries is also an alternative.  Dr. Viju Jacob, a pediatrician in the Bronx says, “A lot of border towns in Mexico have pharmacies set up not so much for Mexicans, but for Americans driving across the border to purchase medications.” In Mexico prescriptions are not needed to purchase medication.  As the drug is generally used for ulcers, it may be easier to buy under the guise of stomach related issues.

On a trip to Neuvo Progreso, a Mexican town not far from the U.S. border, Liza Fuentes, former Research Associate at National Latina Institute for Reproductive Health attempted to buy misoprostol in a local pharmacy.  “I asked him [pharmacist] if I could have misoprostol and he was willing to sell it to me,” she recalled.  The pharmacist gave her three options.  She could pay $50 for a pack of the generic brand, $150 for the brand name pack of Cytotec, or pay $10 a pill, all prices that are higher than the usual cost of per thirty-five cents a pill.  “He wasn’t worried at all,” she said.  “He was explaining the dosage to me in Spanish and rubbing his stomach.  He did not whisper about it.”

Despite the risks of self-inducing, many physicians believe that it’s a fairly safe and inexpensive alternative for women, if used correctly and at the appropriate gestational age. “It’s certainly safer than illegal abortions”, says Dr. Aronoff, Assistant Professor of Infectious Disease at the University of Michigan.

With the cost of an abortion ranging from $400 to $1000, self-induction starts looking like a fairly cheap alternative for those who can’t afford the procedure.  In a recent qualitative study published in Reproductive Health Matters, women shared their experiences with the drug and the realities of self-induction.  Among the women who used misoprostol, cost and access to a clinic impacted their decision to use the drug.

While health care providers have an idea of how women are getting the drugs, it has been hard to get specific details.  For the woman who self-induced in the Bronx, she would not tell her doctor where the pills came from.  Like other women taking the drug, they do not want to get their friends, relatives or sellers in trouble.

Below is a story about what I encountered when I shadowed a resident for a day.

Long hours, little downtime, and in some cases, training through trial and error.  Check on patient, make sure they’re stable, speak with nurses, write notes and move on to the next patient.  Such is the life of a resident.

The doctors’ first patient was a man who had recently undergone a surgical procedure on his prostate.  It would be helpful if the patient described what he was feeling, but instead only moaned in agony while the doctor tried to figure out what was wrong. After a few minutes with the patient, the doctor spoke with the nurse handling the patient and ordered that he receive more pain medication.  “Currently he has a fast irregular heart beat, which is our main concern,” the doctor said.  He begins writing notes for the patient, indicating that the plan for the day, which is something that residents decide for each patient, will be to find out why the patient is in pain and to lower his heart rate.

With his coffee in hand, the doctor quickly slips into stairwell “G”, jogging up two flights of stairs to his next patient.  Over the next few hours, he visited  many patients with different ailments.  One included a young man who had to have tissue removed from his scrotum due to severe infection.  The doctor told another resident, “It was like gangrene.  As soon as I walked in, I told him if he needs more pain medication to let me know.”

Another elderly women, who suffered from peripheral vascular disease, triggered by her diabetes, had already had one leg amputated and was hospitalized for kidney failure.  Upon checking her other leg, her toes resembled charcoal.  When asked if additional surgery would be needed to remove her toes, the doctor said, “No, they will eventually fall off on their own.”

For the typical resident, it’s an 80-hour workweek, with shifts up to 24 hours long.  One of the interns on the doctors’ team mentioned that she is used to the routine, but admits the hours take a toll on her.  “By the time I get home, I just want to sit on the couch and relax,” she says.  “There’s no way I’m going to the gym!”

To become a doctor, students must complete four years in medical school, three years as a resident, and if they would like to specialize, additional training is needed.  The doctor I had shadowed, who at the time was a 3rd year resident, plans on specializing in cardiology, which will require an additional three years of training.

Moving onto the next unit the doctor visits a woman who’s in a coma, the result of brain damage due to a heart attack.  Despite her plight, her family has requested that she be kept alive.  She has tubes coming from her mouth, nose and head, among others.  “Ideally, DNR is something we like to discuss with patients or their family before this situation arises,” says the doctor.  DNR, or “do not resuscitate” is an option that all patients have.  However, because this patient was unconscious upon arriving in the hospital, her family made the call.

In a typical day, residents may be responsible for as many as twenty patients.  These include new admissions, current patients, and “cross over” patients, known as patients that require medical care from more than one specialty.  By noon, the doctor had seen over 10 patients and hadn’t skipped a beat.

In the afternoon, the doctor visited an undocumented citizen who was transferred from another hospital for testing on a pancreatic mass.  “He can’t get this done as an outpatient because he doesn’t have health insurance and then he’ll have to pay for it, so we’re keeping him here to do his tests,” he said.  The doctor explained that this was not an unfamiliar situation adding, “There are people who literally get off the plane [from foreign countries] and say take me to the hospital.”

While in between patients, interns and residents often end up sharing patient updates.  One of the interns wrote up discharge instructions for a patient, while another called the hospitals lab to complain.  “I just don’t get it with these labs,” she said.  “It’s like there’s a big black hole where everybody’s labs go.  All we’re waiting for is Jimenez’ labs, and they can’t find them.” Apparently this sort of problem is not uncommon.  “It happens almost daily,” she explained, saying, “Because of the number of labs we do on patients there’s just so many steps where mistakes can be made.”

As the evening progressed, some of the interns looked forward to heading home at midnight.  However, they knew that the chances of actually leaving at midnight were slim.  If a patient was admitted at 11:59pm, they’d had to take it, which could result in them leaving hours later, only to return again in the morning.  For the doctor, an admission didn’t matter, because he was just half way through his shift.  Working a 24-hour shift today he said, “I might be able to get a couple hours to sleep if I’m lucky.”

As we got ready to leave Rita’s room, one of the interns went to use the faucet in the bathroom, only to find a male patient inside, sitting on the floor with the door closed.  It turned out that the patient had ventured out of his unit and over to another.  The patient did not speak English and initially, no one knew where he belonged.  After bringing him back to the appropriate unit, his nurse asked the head nurse if she could be one-on-one with him for her shift saying, “I think he’s a hazard to himself.”  However, her request was not granted.  As put by the head nurse, “We just do not have the staff for that.”

Hospital Mini Series Part 1

Four medical interns search the supply room for a rectal tube.  “I got the lube,” says a third-year medical student, as they continue to look for it.

The interns are preparing to insert a rectal tube into one of their patient’s.  The patient, Rita is about 70 years old.  Her stomach is so distended that she looks as though she’s nine months pregnant.  Rita is struggling to pass her bowels, which has resulted in large pockets of air becoming stuck in her colon.  By inserting the rectal tube, the interns will be creating a passageway allowing the air and feces to be released.

When they can’t find the right tube, one of the interns decides to try a different one.  “This should work,” she says.  “I’m just going to do what the GI [gastrointestinal] told me to do.  Put the tube in… right?”  However, the nurse working with Rita disagreed, and made the intern wait until the proper tube was provided.

Upon entering Rita’s room, the interns tell her that they need to insert a tube into her rectum to help relieve the pressure in her abdomen.  She agrees, but isn’t told one key factor—that neither of the two interns in the room have ever done this procedure before.

Because Rita only has one leg, resulting from an amputation, one intern starts to turn her on her side and hold her hand while the other lubes up the tube and starts to insert it into Rita’s rectum.
Needless to say, Rita is very upset and uncomfortable as the intern inserts the tube about six inches into her bottom.  The tube falls out, and has to be reinserted—four times.  Each time Rita becomes more upset crying, “No, no, no.  Just take it out!”

Once the tube finally stays in, fluid and air start to drain out, but the interns forgot to attach a foley to catch the excrements, and they begin to spill out onto her bed and floor.  Another intern is called in, the foley is attached, and the procedure is finally over.  The interns then returned to the nursing station, where they updated patient paperwork.

Such is the life of an intern.

Stay in tune for my upcoming blogs… I think I am going to start with a short series on the hospital environment, looking at perspectives from both patients and doctors.  I hope you enjoy!

The vaccine, created to prevent cervical cancer was approved by the Food and Drug Administration in 2006 and then recommended by the Advisory Committee of Immunization Practices (ACIP) for females aged 11-26.  Two years later, the United States Citizenship and Immigrations Services (USCIS), added Gardasil to the required vaccine list for female immigrants.

According to the Immigration and Nationality Act (INA), any vaccine recommended by the United States government becomes a requirment for immigrants, and in this case, even if not required for American citizens.  For immigrant and women advocates, requirement of the HPV vaccine caused the creation of a whole movement to have the vaccine taken off the required list for immigrants.  Among them was Priscilla Huang, Policy and Program Director of the National Asian Pacific Women’s Forum in Washington D.C.

“They [CDC] realized early on that this wasn’t the right way to impose vaccines on immigrants, which was good, because it meant they wanted to fix it”, she said.

The requirement of Gardasil for immigrants raised red flags quickly.  Out of the 14 vaccines required for immigrants, Gardasil was the only required vaccine that did not fight infectious diseases spread through respiratory route.  Questions were also raised about the vaccines effectiveness, and short clinical studies.  Not to mention that Merck, the pharmaceutical company which developed the vaccine, spent millions of dollars advertising the vaccine- a small price to pay considering that over $694 million worth of vaccines were sold in 2008.

Apparently, the combination of pressure from advocacy groups and questions about long term effectiveness of the vaccine caused the CDC to rethink the language of the law. As a result, the revised language indicates that in order for a vaccine to be required, it needs to be age appropirate, protect against a disease causing outbreaks, and be for a disease that has been erdicated in the United States, taking Gardasil off the list.

While we may never know what prompted the change, the CDC claims that Gardasil was not the main reason. “The change was not designed with Gardasil in mind, but with what makes sense and what people can get later,” said CDC spokesmen Christine Pearson.  And although taken off the required list, immigrants are urged to make informed decisions about further vaccinations once in the country. “These are valuable vaccines and we will urge immigrants to get these vaccines once they have arrived in the United States, but not as part of the immigrant process,” Pearson went on to explain.

Revisions to vaccine requirement criteria will now create an intermediate step between the CDC’s advisory committee recommendations and vaccines becoming an automatic requirement for immigrants.  “The fact that women and girls will no longer be required to get the HPV vaccine to adjust their immigration status allows immigrant women to make an informed choices about the risks and benefits of the vaccine, and whether they want it”, says Veronica Bayetti, Senior Policy Analyst at the National Latina Institute for Reproductive Health. “Additionally, this removes what could be an insurmountable cost barrier, as the vaccine and its administration may cost up to $1000.”

The change in requirements will become effective on December 14, 2009.  As a result, as new vaccines come out, the same criteria will be used to decide which vaccines should be used in the immigration process, with reviews occuring periodically.

One argument you may hear against health care reform concerns cancer survival rates. The United States has higher cancer survivor rates than countries with national health care systems, we’re told. Doesn’t this mean we should keep what we’ve got and not change it?

Certainly cancer survival rates are a critical issue for people suffering from the deadly lung cancer mesothelioma.  So let’s look at this claim and see if there is any substance to it.

First, it’s important to understand that “cancer survival rate” doesn’t mean the rate of people who are cured of a cancer. The cancer survival rate is the percentage of people who survive a certain type of cancer for a specific amount of time, usually five years after diagnosis.

For example, according to the Mayo Clinic, the survivor rate of prostate cancer in the United States is 98 percent. This means that 98 percent of men diagnosed with prostate cancer are still alive five years later. However, this statistic does not tell us whether the men who have survived for five years still have cancer or what number of them may die from it eventually.

Misunderstanding of the term “survival rate” sometimes is exploited to make misleading claims. For example, in 2007 a pharmaceutical company promoting a drug used to treat colon cancer released statistics showing superior survival rates for its drug over other treatments. Some journalists who used this data in their reporting assumed it meant that the people who survived were cured of cancer, and they wrote that the drug “saved lives.” The drug did extend the lives of patients, on average by a few months. However, the mortality rate for people who used this drug — meaning the rate of patients who died of the disease — was not improved.

But bloggers and editorial writers who oppose health care reform seized these stories about “saving lives,” noting that this wondrous drug was available in the United States for at least a year before it was in use in Great Britain. Further, Britain has lower cancer survival rates than the U.S. This proved, they said, the superiority of U.S. health care over “socialist” countries.

This is one way propagandists use data to argue that health care in the United States is superior to countries with government-funded health care systems. They selectively compare the most favorable data from the United States with data from the nations least successful at treating cancer. A favorite “comparison” country is Great Britain, whose underfunded National Health Service is struggling.

It is true that the United States compares very well in the area of cancer survival rates, but other countries with national health care systems have similar results.

For example, in 2008 the British medical journal Lancet Oncology published a widely hailed study comparing cancer survival rates in 31 countries. Called the CONCORD study, the researchers found that United States has the highest survival rates for breast and prostate cancer. However, Japan has the highest survival for colon and rectal cancers in men, and France has the highest survival for colon and rectal cancers in women. Canada and Australia also ranked relatively high for most cancers. The differences in the survival data for these “best” countries is very small, and is possibly caused by discrepancies in reporting of data and not the treatment result itself.

And it should be noted that Japan, France, Canada and Australia all have government-funded national health care systems. So, there is no reason to assume that changing the way health care is funded in the U.S. would reduce the quality of cancer care.

— Barbara O’Brien

Photo courtesy of http://www.bartcop.com/

If you get your period once a month, you should know that you have a “pre-existing condition”.  Pregnant, or had a caesarean section?  When it comes to health insurance, you are branded with the Scarlett Letter- “W”.

Basically, being born as a women puts you at an automatic disadvantage for receiving affordable health care– something male counterparts don’t have to worry about.

Take for example, Linda Bettinazzi, owner of a home health company in Pennsylvania.  Her company is charged $2,000 more per employee than the national average for single coverage, a staggering $6,800, because majority of her employees are women. (for full report at Kaisers Health News, click here)  Or what about the pregnant young women who tries to get private health insurance and is deemed “uninsurable” because she is carrying a baby? Unfortunately gender discrimination of this type is common in America.

This is not to say that gender based discrimination is being swept under the rug.  Advocates fighting for equality, such as The National Women’s Law Center have taken on the issue, and are pushing for health reform to change the system. One way this is being done is through the Law Center’s “A Women is Not a Preexisting Condition” website, which is asking advocates to send letters to Congress.(click here for petition)

To learn more about gender discrimination in health care, click here.

So what’s the problem here?  The biggest is money.  Many stakeholders, including government officials, insurance companies and big pharma are against a unified strategy because it will hinder their profits.  Ever since the thought of universal health insurance was created, massive efforts have been made to drop the idea, with the insinuation that America would become a government run, socialized medical society.  As a result, it has been over 50 years that we continue to fight for health insurance for all.

Even though the topic has been brushed under the carpet for decades, it is interesting to see that it comes up again year after year.  But if we look at the statistics, it’s easy to see why.

In the country known as the land of opportunity, we have 46 million people without insurance, not to mention all the others that are underinsured.  Even worse is that the U.S. Census Bureau estimates that 4.5 million of the uninsured are children.

But wait, there’s hope.  After half a century, America may finally join the worlds developed nations with an “Americanized” version of universal health care.  After much debate and slander, President Obama was finally able to unveil his health care proposal in early September, taking a step in the right direction for America.

Under his plan, we will keep our current system, making tweaks and additions along the way.  This means that we will continue to have employer-based insurance, an individual market and Medicare and Medicaid in place.  But is having a whole bunch of different health insurance sectors the best solution?  One might have to say that beggars can’t by picky.  After all, something is better than nothing.

The country is currently going through the biggest recession since the Great Depression.  And although we’re starting to see the light at the end of the tunnel, for the 46 million uninsured Americans that light has been pretty dim.  In the last two years, we have seen dramatic increases in unemployment.  For many of these people, the loss of their job has also meant the loss of their health insurance.

According to a report on insurance insecurity, loss of employer-sponsored insurance is more likely to lead to uninsurance than coverage in the individual market.  What’s worse is that for employees fortunate enough to keep their jobs, there is the risk that an employer will drop coverage for employees because the sticker price of health insurance keeps rising—at a rate much higher than wages.

A major flaw of American society is that we are preoccupied with ourselves.  The result is that if we have health insurance, we don’t care about the other 46 million people at risk of bankruptcy.  However, there’s a problem here.  What many people don’t realize is that even though you’re covered, your taxpayer dollars are paying for every emergency room visit that one of those 46 million uninsured Americans makes.  Equally important is knowing that a lack of insurance is not only a problem for the low income population.  In fact, the problem can be found in your own back yard.  The middle class have also fallen victim to the loss of health insurance.

While Obama’s plan fails to create one centralized form of universal health insurance, one of the best things he has proposed is tightening regulations on insurance companies– many of which would rather drop your coverage than pay for you to live through a major illness.

Insurance companies will no longer have the right to rescission, the act of canceling an individual or family plan in the event of a catastrophic illness.  This is a practice which has literally meant life or death for many Americans, and it’s all for the almighty dollar.   They will also no longer be able to put caps on coverage, and a limit will be put on the amount of out-of-pocket expenses that we are responsible for.

The next benefit of his proposal is that everyone will be required to obtain some form of health insurance, putting less of the cost burden on those of us that already have health insurance.  With everyone insured, a major benefit will be less money coming directly out of our pockets.  After all, reducing concerns about health costs for 46 million uninsured people will have staggering effects on the economy.  It will bring business to insurers and rightful coverage to more people.

Lastly, by focusing on reducing wasteful spending, we can hope to finally see health care costs contained.  Considering that health insurance premiums have almost doubled since 2000, increasing almost three times quicker than our salaries, that light at the end of the tunnel might start looking a little brighter.

Because health insurance in America has been a for-profit business for so long, creating a unified and central system may be something that we’ll never see.  However, if President Obama can do “the next best thing” and make it work, both strategically and financially, the bottom line will be benefits for everyone.  After all, if we can’t centralize the system, we might as well have one that reaches out to every American, helping us all get the health care we deserve.