In today’s Dose:
Health care reform
(Kennedy-Dodd committee proposal released)
Health news
(Is Tylenol (acetaminophen) safe to take every day?)
Aging
(Doctors lack training in care of the elderly)
Pop culture
(Michael Jackson and Diprivan (propofol), Jackson’s weight, Jackson’s doctor)
Health care reform
- The Senate health committee proposal on health care has been released. Turns out all that fuss over the Congressional Budget Office (CBO) report was for nothing, as could have been predicted. The CBO’s report was based on a very incomplete proposal. This roller coaster reporting on health care reform will continue throughout July. Congress would like to wrap things up before their August recess.
There are lots of stories today on the Kennedy-Dodd plan just released. This one from Bloomberg has lots of details. The cost is now $600 billion, not over a trillion. 20 million or 3 percent of Americans would not be covered by health insurance. The previous estimate had been over 30 percent. On the issue of the insurance industry raising premiums for those who become ill:
The proposal would prevent insurers from varying premiums for a given plan according to an individual’s health and would only allow them to peg premiums to age “to a limited degree,” CBO said. The restrictions would only apply to new insurance policies, the agency said, allowing already existing ones to be exempt from the rules.
- There’s a good summary of reactions to Obama’s town hall meeting in Annandale, VA at Kaiser Health News.
The Associated Press reports that Obama put “a human face” on health care reform by hugging a cancer patient, but gave few new details on his health care reform plans. … “The president would bar insurance companies from turning down applicants because of their “pre-existing conditions.” …
Bloomberg reports that Obama “stepped up his drive to overhaul the health-care system, saying that the U.S. economy has been “weakened by the crushing cost” of care and the economy will “just sputter along” without changes. …
The Los Angeles Times reports: “The president issued a pointed critique of the institution where he once served, warning that lawmakers often are tempted to shunt aside politically sensitive issues. …
Roll Call reports (subscription only): “Obama stressed the need for a “health insurance exchange” that would provide a “one-stop shop” for consumers to compare the prices and benefits of various plans — including what’s been called a public option — none of which would discriminate based on medical history. …
[T]he Wall Street Journal reports: “Obama, after picking fights with rivals over health care during the election campaign, is signaling flexibility on many of his previous stances as he tries to put a health-care deal together.”
Health news
- There’s a good summary from Time on the latest FDA pronoucemnets on Tylenol (acetaminophen). Stories in the news so far have been clear that the problem of liver damage stems from an overdose. Of course, the new definition of an overdose is the recommended dose of arthritis-strength products. All this talk about the dangers of Tylenol makes people wonder if it’s safe to continue using the pain- and fever-reliever at any dose.
Many people take Tylenol daily to relieve pain from chronic conditions such as arthritis, or they take Tylenol PM regularly to help them sleep. If taken as directed, doctors say these products are safe. At issue is the maximum daily dosage, which people may inadvertently exceed when taking a combination of medications that contain acetaminophen. Most people do not realize that the ingredient is present in so many different popular over-the-counter remedies.
60 percent of acetaminophen-related liver damage is associated with prescription drugs, such as Vicodin and Percocet. Only 10 percent is associated with non-prescription pain tablets. And a good number of those are suicide attempts. One of the problems with mixing acetaminophen with a narcotic drug is that, over time, patients increase their consumption.
“How can you mix a highly addictive drug with one that can cause toxicity at high doses?” says Dr. William Lee, director of the Clinical Center for Liver Diseases at the University of Texas Southwestern Medical Center. Lee presented data to the [FDA] committee on liver damage due to acetaminophen overdose. “It’s like putting poison in a candy.”
Gregory House, MD, have you had your liver checked lately?
Aging
Dr. Rosanne Leipzig has an editorial in today’s NY Times that highlights how dangerous it is to be sick and in a hospital if you’re over 80.
[H]ospitals across America are welcoming new interns, fresh from medical school graduation. … All medical students are required to have clinical experiences in pediatrics and obstetrics, even though after they graduate most will never treat a child or deliver a baby. Yet there is no requirement for any clinical training in geriatrics, even though patients 65 and older account for 32 percent of the average doctor’s workload in surgical care and 43 percent in medical specialty care, and they make up 48 percent of all inpatient hospital days.
The symptoms and treatment of many common conditions are significantly different at age 80 than they are at age 50. Dr. Leipzig was one of the contributors to the “Don’t Kill Granny” list. The complete “Keeping Granny Safe” article, which appeared in the journal Academic Medicine, is available online without a subscription.
Pop culture
- Most of the stories I see about whether Michael Jackson took the sedating drug Diprivan (propofol) for insomnia are in tabloids or from television news. There is one report in the Los Angeles Times, but it’s all speculation. Dr. Kevin Pho of KevinMD is skeptical.
There are zero circumstances where propofol should ever be used for insomnia. This medicine is used for general anesthesia or to sedate patients in the intensive care unit who are intubated and on a ventilator. In fact, patients have to be monitored very closely when on the drug because the risk of respiratory arrest is so high.
And that’s why I find it incredible that, again according to reports, Jackson had “claimed to have received the drug before, but didn’t disclose who had injected him with it.”
It’s against FDA guidelines to have propofol in the house, and as an anesthesiologist puts it, “Using this drug for insomnia is sort of like using a shotgun to kill an ant.”
That is some serious malpractice, bordering on criminal, if any doctor had indeed injected Jackson with Diprivan simply to help him sleep.
- Dr. Kevin’s assessment of the cause of death includes being dangerously underweight:
I continue to believe that a combination of Mr. Jackson’s weight, with a body mass index of 17.9, in combination with possible dehydration and probably narcotic use, all were plausible factors leading to respiratory arrest, and subsequently causing his fatal cardiac arrest.
The low end of what’s considered a normal body mass index (BMI) is 18.5. A BMI of 17.5 is the cutoff for diagnosing anorexia nervosa.
- The New York Times reported on Jackson’s personal cardiologist, Dr. Conrad Murray:
Dr. Murray, who public records show is a 56-year-old cardiologist with a practice in Las Vegas, has lived in numerous homes over the last decade in several states, filed for personal bankruptcy in 1992 in California and has five tax liens against him for hundreds of thousands of dollars.
Toni Brayer, at Everything Health, asks: “Why do Celebrities Have Bad Doctors?”
Whenever I see a movie star that had bad plastic surgery or recall Nicole Smith’s doctor who kept her in a drug induced state until her sad death, or think about Barry Bond’s infected knee surgery or any number of celebs that get bad medical advice, I wonder what the heck is going on. These folks can afford the best medical care and the best doctors. Why do they end up with doctors that are obvious quacks and deserve to have their licenses revoked?
A friend of mine is a rock musician and has traveled with many major rock groups over the years. He said those groups always had a quack doctor touring with them that would keep them supplied with drugs, B12 shots and anything else they needed.
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