Watch Your Back! How the Back Pain Industry is Costing Us More and Giving Us Less - And What You Can Do to Inform and Empower Yourself in Seeking Treatment

[Excerpt] This book considers what we know about treatments for back pain and asks a number of critical questions. Are some of the most popular treatments really effective? Do they “cure” or even improve the problems they claim to address? If some back pain treatments are ineffective or even harmful, why do patients clamor for them and doctors provide them? Who benefits from the vast back pain industry that’s developed over the past thirty years? Is it patients? Or the doctors, hospitals, and man­ufacturers that produce the technology of back pain therapy? What does all this say about our medical system? Or our efforts to enhance quality, improve safety, and reduce health care costs? How can patients maneuver to help themselves rather than help the medical industry? Will efforts to measure patient satisfaction help deliver safer and more effective treatments or encourage the opposite? In answering these questions, this book does more than describe and analyze the back business. It also explores the complex ways that doctors interact with patients, drug companies, and medical device makers. The results can inadvertently lead to treatments that are inef­fective or even harmful

The Patient Centered Medical Home-What Employers Need to Know

In their capacity as payers for their employees’ medical services, employers need to be aware of trends that impact the provision and payment of healthcare services. One such trend in primary care healthcare services – specifically, the Patient Centered Medical Home (PCMH) - meets both of these criteria by providing financial incentives to physicians for meeting certain quality criteria. In the following paragraphs, I’ll elaborate on the concepts underlying the PCMH, its potential to impact quality and cost of patient care, and some of the barriers to its implementation

THE EFFECT OF LANGUAGE BARRIERS ON VARIATION AND RECEIPT OF EARLY STAGE BREAST CANCER TREATMENT

Background: Arriving at and implementing an appropriate patient centered treatment plan for early stage breast cancer requires significant dialogue between healthcare providers and patients. How language barriers affect this process has not been thoroughly explored in the literature. The aim of this paper is to examine the effect of language barrier on variation and receipt of early stage breast cancer treatment. Methods: Rates of lumpectomy, mastectomy, and contralateral prophylactic mastectomy (CPM) with or without reconstruction were compared between English speaking and Low English Proficiency (LEP) cohorts. Patients with recurrent or bilateral breast cancer, male patients, and/or known genetic mutations were excluded. Receipt of recommended treatments including chemotherapy, hormonal therapy and radiation were compared between the two groups, as well as patient refusal and loss of follow-up. Regression analysis for all-cause mortality within this time period was tabulated for each group. Results: There were no significant differences between receipt of recommended treatments, patient refusal or loss of follow up between the cohorts. LEP patients had a greater proportion of lumpectomies (79.7 versus 70.7%) while 9.2% of English-speaking patients had CPM or CPM with reconstruction compared to none of the LEP patients. These trends, however, did not rise to statistical significance within our small population sample. Age, insurance type, and LEP were associated with significant difference in all-cause mortality, however only age and insurance remained significant in adjusted analysis. Conclusion: Our results indicate a non-statistically significant trend towards less variation of surgical treatment variation for early stage breast cancer in the LEP population, including a greater frequency of lumpectomy and less utilization of CPM. Larger, multicenter studies would be needed to affirm and further investigate these trends

Nitrous oxide myelopathy posing as spinal cord injury.

The authors describe a patient who presented with acute tetraparesis and a proposed acute traumatic spinal cord injury that was the result of nitrous oxide myelopathy. This 19-year-old man sustained a traumatic fall off a 6-ft high wall. His examination was consistent with a central cord syndrome with the addition of dorsal column impairment. Cervical MRI demonstrated an isolated dorsal column signal that was suggestive of a nontraumatic etiology. The patient\u27s symptoms resolved entirely over the course of 48 hours. Nitrous oxide abuse is increasing in prevalence. Its toxic side effects can mask vitamin B12 and folate deficiency and central cord syndrome. The patient\u27s history and radiographic presentation are key to establishing a diagnosis

Today\u27s cigarette and e-cigarette landscape

E-cigarettes are one of the most difficult and complex public health issues most of us have confronted. Most anti-tobacco experts and advocates line up on a spectrum from embracing e-cigarettes as a promising way to reduce the harm of tobacco products all the way to being the greatest threat to progress in our 60 year war on big tobacco

An American medical economics phenomenon

The author reflects on his own experience with medical economics-driven phenomena in healthcare