What Money Doesn't Buy in Healthcare

www.nytimes.com

In a packed hearing room at the Food and Drug Administration last week, a panel of cardiac experts met to consider what was obviously an important question: Has one of the most popular treatments for heart disease in fact been killing some of the patients it is meant to help?

Three years ago, doctors began using a new device called a drug-coated stent — a tiny metal tube — to keep blocked heart arteries open. It cost a lot more than an uncoated stent, but because it seemed to be far more effective, it quickly began to dominate the stent market. Last year, Johnson & Johnson and Boston Scientific together sold more than one million drug-coated stents. They have become a primary treatment for this country’s No. 1 cause of death.

In recent months, though, researchers found a disturbing pattern. People with a drug-coated stent seemed unusually vulnerable to blood clots in later years. The new stents solved one problem, but they may have created another. So the F.D.A. summoned its cardiology advisers to review the evidence.

After listening to testimony, they concluded that for healthier patients with simple forms of heart disease, the benefits of drug-coated stents appeared to outweigh the risks. The picture was less clear for people with diabetes, multiple blocked arteries or other complications. In the end, the panel concluded that doctors and patients needed to be aware of the risks and that researchers should continue collecting data. The entire affair — from the invention of the new stent to the willingness to reconsider it — was in many ways an impressive display of American medicine.

Yet it was also a nearly perfect example of what’s wrong with our health care system.

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Five Companies to Launch Electronic Health Files

http://www.latimes.com

WASHINGTON — Five major U.S. corporations have joined forces to create a "medical Internet" on which some 2.5 million people can compile their personal health records in one location, providing convenient access to everything from prescriptions and cholesterol readings to family medical histories.

The system, unveiled Wednesday, could reduce the chances of medical mistakes, improve treatment of chronic illnesses and eventually save billions of dollars by avoiding duplicative services, its designers say. Currently such information — often cumbersome paper records — is scattered among the files of a patient's doctors, pharmacists and other care providers, making it difficult to coordinate treatment.

If the experiment works, experts say, most of the country could follow suit in five to 10 years, though privacy advocates say stronger safeguards are needed.

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Independent Review Organizations for Peer Review

http://www.physiciansnews.com

It’s no secret hospital peer review is a broken process. Its intent – improving the quality of care for patients by protecting them from substandard medical care – is an admirable goal and one that doctors and hospital risk managers agree on. Everyone wants patients to have consistent, high quality treatment. Peer review tries to assure this by having the same specialty and practicing doctors not involved in the procedure in question look over the case. In theory, doctors trained and practicing in a specialty can examine the problematic event and provide objective, unbiased determinations on its cause. They should consider whether the treatment was medically needed; whether it followed the standards of care; whether there was a sentinel event; and if so what was its cause. However the theory conflicts with application.

Unfortunately, institutions handling peer reviews internally soon find many flaws in the process. Internal peer reviews impact doctors’ time, bring out competitive and personal biases and, more often than not, the doctors conducting the reviews are not working in an equivalent subspecialty.

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