By Bob Aronson
I am a senior citizen, who has had a heart transplant and who also has Chronic Obstructive Pulmonary Disease (COPD). I take a good number of prescription drugs and despite having Medicare Part D insurance I still pay thousands of dollars a year for my prescriptions. Most of the drugs I take have been around for quite a while, but not long enough to allow the sale of generics and because there are few if any pricing restrictions, most of my meds are outrageously high priced.
One of the drugs I take is called Foradil. It was approved by the FDA in February 2001 for the maintenance treatment of asthma and the prevention of bronchospasm in reversible obstructive airways disease.. Despite being on the market that long, it still retails for about $250.00 for a 30 day supply. Spiriva is another COPD drug and is often taken with Foradil. It retails for about $350.00. I take about a dozen drugs and these two alone total over $600.00 a month. Insurance cuts that cost in half, but they are still expensive. Because of these prices I know of many seniors and others who have to choose between eating and paying for their prescription meds.
It is an unfortunate fact of life that prescription drugs are more expensive in America than any other place in the world and as a result if you contract a serious illness like cancer you may not be able to afford the treatment that can save your life, even if you are insured.
It costs a whole lot of money to be sick in this country and a whole lot of people die — not because there is no medicine or treatment but because they can’t afford to get well. That strikes me as being just plain wrong.
Healthcare costs are skyrocketing, but prescription drugs lead the parade. Americans now spend a staggering $200 billion a year on them and the end is nowhere in sight. The cost of staying alive is growing at the rate of about 12 percent a year. It appears as though people are taking a lot more drugs than they used to and they are taking the really expensive new ones instead of older, cheaper drugs. The reason? Either physicians are pushing new medications too hard or, more likely, people are seeing the ads for new drugs in the media and are demanding them. Strangely, unlike most other businesses where prices come down with time, that’s not true with drugs. Price increases are commonplace even with the older ones and the increases aren’t one time adjustments. Often the price tag increases several times a year.
Earlier I pointed out that Americans pay more for their drugs than any other country in the world — but it isn’t just a little more…it’s a whole lot. On average, the cost of prescription drugs in the U.S. is at least double what people in other countries pay for the same exact prescription and it some cases it is 10 times more.
A 2013 report from the International Federation of Health Plans, says Nexium, the pill commonly prescribed for acid reflux, costs U.S. patients more than $200, while Swiss citizens only pay $60 and people who live in the Netherlands pay $23. But Nexium is a drop in the bucket compared to cancer drugs. http://www.drugwatch.com/2014/10/15/americans-pay-higher-prces-prescription-drugs/
Not long ago CBS’ 60 Minutes devoted a segment to the absurdly high cost of cancer drugs. Correspondent Lesley Stahl reported that many cancer drugs cost well over $100,000 for a year’s worth of medicine. She said that in the fight against cancer, most people can expect to be on more than one drug. The bill for medications can escalate to nearly $300,000, a price tag that doesn’t include fees charged by a doctor or a hospital. Health insurance companies – including government polices like Medicare – don’t cover the full cost of these drugs. Some policies don’t cover some of these drugs at all. But cancer is not alone in the extreme price arena. Drugs for chronic diseases like multiple sclerosis also carry inflated prices. Prescriptions of Copaxone and Gilenya cost about $4,000 and $5,500, respectively and that amount is almost three times more than the most-expensive price in other countries.
In the case of almost every other product sold on the free market, the older a product gets the less it costs. In the case of cancer drugs in America, the inverse is actually true. Novartis developed Gleevec, one of the most popular cancer drugs, in 2001 and sold it for $28,000 a year. By 2012, its cost rose to $92,000. Despite not being a novel treatment, Novartis is allowed to hike up the price every year in the United States.
So If you are a reasonably intelligent person you will ask three questions. 1) Why do these drugs cost so much? 2) What is being done to bring the prices down? And 3) Is there help available to people who can’t afford the drugs that can keep them alive.
Let’s answer the questions one at a time. First. Why are drugs so expensive? Well, if you listen to the big pharma companies they will tell you that the cost reflects their investment in research and development of the drugs. They will tell you they spend millions on drugs that don’t pan out and that expense is passed on to the patient. But are they telling the truth? No they aren’t! Pharmaceutical companies are fond of saying Americans take the lion’s share of the R&D costs for the rest of the world – calling other countries “foreign free riders.” So, drug companies are forced to charge Americans more to recover what they don’t get from other countries.
In fact, the more disturbing truth is that companies charge what they want in the U.S., and it’s a profiteering paradise for them. U.S. law protects these companies from free-market competition. For example, Medicare is not allowed to negotiate prices. By law, it has to pay exactly what the drug companies charge for any drug. In effect our lawmakers told the pharmaceutical companies that they can charge whatever they want and we (the taxpayers) will pay it. Even may insurance companies don’t negotiate or do it half-heartedly. Companies make billions on most of these drugs, and they receive massive tax breaks for R&D, leading to inflated figures. Another huge portion of the costs are subsidized by taxpayers.
Here’s the sad part of all this R and D and the introduction of new drugs. Only 1 in 10 of them actually provides substantial benefit over old drugs. To add insult to injury the side effects of the new entries create the need for more drugs. And — some of these drugs have horrible complications that result in lawsuits to recover damages.
University of Medicine and Dentistry of New Jersey Health professor and policy expert Donald W. Light says, “We can find no evidence to support the widely believed claims from industry that lower prices in other industrialized countries do not allow companies to recover their R&D costs so they have to charge Americans more to make up the difference and pay for these ‘foreign free riders,’”
In contrast, governments in other countries put caps on the price of drugs and negotiate prices based on what the actual therapeutic benefit is. And Big Pharma still turns a healthy profit in other countries, despite costs being 40 percent lower than they are in the United States.
Big Pharma would have many Americans believe that it is disadvantaged by the costs of developing a new drug. The truth is, drug companies are far from impoverished. EvaluatePharma’s most recent report shows that 2013 was the biggest year since 2009 for drug approvals. These new drugs will add nearly $25 billion to Big Pharma’s coffers by 2018, and prescription drug sales will exceed one trillion dollars by 2020.
The health care industry as a whole has more than enough money, with billions left to continue pursuing its interests in Washington.
Big Pharma Spends More on Lobbying Than Anyone
Since 1998, the industry spent more than $5 billion on lobbying in Washington, according to the Center for Responsive Politics. To put that in context, that’s more than the $1.53 billion spent by the defense industry and more than the $1.3 billion forked out by Big Oil.
From 1998 to 2013, Big Pharma spent nearly $2.7 billion on lobbying expenses — more than any other industry and 42 percent more than the second highest paying industry: insurance. And since 1990, individuals, lobbyists and political action committees affiliated with the industry have doled out $150 million in campaign contributions.
The world’s 11 largest drug companies made a net profit of $711.4 billion from 2003 to 2012. Six of these companies are headquartered in the United Sates: Johnson & Johnson, Pfizer, Abbot Laboratories, Merck, Bristol-Myers Squibb and Eli Lilly. In 2012 alone, the top 11 companies earned nearly $85 billion in net profits. According to IMS Health, a worldwide leader in health care research, the global market for pharmaceuticals is expected to top $1 trillion in sales by 2014.http://www.drugwatch.com/manufacturer/
But the large amount of cash Big Pharma bestows on government representatives and regulatory bodies is small when compared with the billions it spends each year on direct-to-consumer advertising. In 2012, the industry invested nearly $3.5 billion into marketing drugs on the Internet, TV, radio and other outlets. The United States is one of only two countries in the world whose governments allow prescription drugs to be advertised on TV (the other is New Zealand).
A single manufacturer, Boehringer Ingelheim, spent $464 million advertising its blood thinner Pradaxa in 2011. The following year, the drug passed the $1 billion sales mark. The money in this business appears to be well-spent.
No sane person can object to a company making a profit, it’s part of the American way, but the drug industry’s profits are excessive. We paysignificantly more than any other country for the exact same drugs. Per capita drug spending in the U.S. is about 40 percent higher than Canada, 75 percent greater than in Japan and nearly triple the amount spent in Denmark.
So you might ask, “What can I do to get the lowest possible price for my prescriptions?” Well, there are a few things. You can shop for the best price and because of the internet that’s become a whole lot easier. You can look up a specific drug and find the best price at a pharmacy near you. Here are two resources, I’m sure you can find a lot more https://www.lowestmed.com/Search#/ or http://www.goodrx.com/ All; you have to do is type in the drug you need and your zip code and it will find the price of that drug in pharmacies near you.
Transplant recipients might be interested in the cost of anti-rejection drugs. The price is hard to stomach but easy to find. In my zip code 32244 100 Mg Cyclosporine capsules range jn price from $526.00 at Wal Mart to $584 at Target. If you are a heart pateint and take Carvedilol in my neighborhood it ranges from $4.00 at WalMart to $9.54 at Kmart . Lisinopril also has a wide range. At the Publix Supermarket pharmacy near me it is FREE…that’s right FREE. But at CVS it is $12.00. Those price variations might make it worth a little longer drive to get a better bargain.
You can also get help with coupons which are an obvious choice to save money when grocery or clothes shopping, but they’re often overlooked as a way to cut costs of over-the-counter and prescription drugs. Manufactures frequently offer one time and repeat coupons that can save consumers hundreds of dollars on their medicines. “For our family it has been incredibly effective [in saving money] for a number of regular prescriptions,” says Stephanie Nelson, founder of the coupon website CouponMom.com.
The costs of prescription drugs and over-the-counter medications have been steadily rising and patients facing tight budgets are often forced to make hard decisions when it comes to what they can afford.
The savings vary by manufacturer, but according to Nelson, many companies offer discounts at each prescription refill while others offer discount cards that take $20 off co-pays. Others offer one-time coupons to cover the first use of a drug.
Consumer Reports Magazine says that there are other ways to save money, too. Whichever drugstore or pharmacy you use, choosing generics over brand-name drugs will save you money. Talk to your doctor, who may be able to prescribe lower-cost alternatives in the same class of drug. In addition, follow these tips.
- Request the lowest price.Our analysis showed that shoppers didn’t always receive the lowest available price when they called the pharmacy. Sometimes they were given a discounted price, and other times they were quoted the list price. Be sure to explain—whether you have insurance or not—that you want the lowest possible price. Our shoppers found that student and senior discounts may also apply, but again, you have to ask.
- Leave the city.Grocery-store pharmacies and independent drugstores sometimes charge higher prices in urban areas than in rural areas. For example, our shoppers found that for a 30-day supply of generic Actos, an independent pharmacy in the city of Raleigh, N.C., charged $203. A store in a rural area of the state sold it for $37.
- Get a refill for 90 days, not 30 days.Most pharmacies offer discounts on a three-month supply.
- Consider paying retail.At Costco, the drugstore websites, and a few independents, the retail prices were lower for certain drugs than many insurance copays.
- Look for additional discounts.All chain and big-box drugstores offer discount generic-drug programs, with some selling hundreds of generic drugs for $4 a month or $10 for a three-month supply. Other programs require you to join to get the discount. (Restrictions apply and certain programs charge annual fees.)
- Consumer Reports goes on to say that “although the low costs we found at a few stores could entice you to get your prescriptions filled at multiple pharmacies based only on price, our medical consultants say it’s best to use a single pharmacy. That keeps all of the drugs you take in one system, which can help you avoid dangerous drug interactions.”
Finally, what do you do if you’ve done the shopping, used coupons, followed all of the Consumer Report Tips and are still unable to pay for your prescriptions. Well, there is some limited assistance. Here are some resources.
Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s over 4,200 member Organ Transplant Initiative (OTI) and the author of most of these donation/transplantation blogs. You may comment in the space provided or email your thoughts to me at email@example.com. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love. You can register to be a donor at http://www.donatelife.net. It only takes a few minutes.
By Bob Aronson
When I was growing up in Chisholm, Minnesota my dad swore that a chiropractor did more for his aching back than anyone else. Dad was a meat cutter (he despised the term “Butcher” because he butchered nothing) and carried quarters of beef from the truck into his supermarket meat cooler. Those things are heavy, bulky and very hard to handle and as a result he suffered back problems all his life. Sometimes he could barely get out of bed he hurt so badly. When that happened he would call Dr. Cole who, like all doctors then, made house calls.
My mom had an old fashioned, very heavy, super sturdy all wood ironing board set up in the living room and that’s what Doc Cole would use as a treatment bed. Dad would lie face down on that old ironing board and Doc Cole would begin doing whatever manipulation Chiropractors do. I don’t remember a time when it didn’t work. Dad always felt better and was back at work the next day, but the pain always returned. That’s the sum total of my experience with Chiropractors. I have never been to see one or been in the care of a Chiropractor nor do I know anyone who has.
Here is the definition of the treatment as provided by the American Chiropractic Association (ACA). Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. Chiropractic care is used most often to treat neuromusculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches.
Doctors of Chiropractic – often referred to as chiropractors or chiropractic physicians – practice a drug-free, hands-on approach to health care that includes patient examination, diagnosis and treatment. Chiropractors have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling (there is much more to the definition. You can read it here http://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=61
There is no shortage of definitions of the practice so “Cherry Picking” a few can be misleading but from what I can find, traditional medical science is becoming more accepting of the practice in recent years, but still seems to stop short of an endorsement. Here is the definition of Chiropractic according to Medicine Net dot com. http://www.medterms.com/script/main/art.asp?articlekey=2706
Chiropractic: A system of diagnosis and treatment based on the concept that the nervous system coordinates all of the body’s functions, and that disease results from a lack of normal nerve function. Chiropractic employs manipulation and adjustment of body structures, such as the spinal column, so that pressure on nerves coming from the spinal cord due to displacement (subluxation) of a vertebral body may be relieved. Practitioners believe that misalignment and nerve pressure can cause problems not only in the local area, but also at some distance from it. Chiropractic treatment appears to be effective for muscle spasms of the back and neck, tension headaches, and some sorts of leg pain. It may or may not be useful for other ailments.
Not all chiropractors are alike in their practice. The International Chiropractors Association believes that patients should be treated by spinal manipulation alone while the American Chiropractors Association advocate a multidisciplinary approach that combines spinal adjustment with other modalities such as physical therapy, psychological counseling, and dietary measures. For some years the American Medical Association (AMA) opposed chiropractic because of what it termed a “rigid adherence to an irrational, unscientific approach to disease.” However, Congress amended the Medicare Act in 1972 to include benefits for chiropractic services and in 1978 the AMA modified its position on chiropractic.
So, now that we have defined terms the question is, “When should I choose a chiropractor to treat a condition, and which conditions can they successfully treat?” The answer to that question depends entirely on who you talk to. Even Chiropractors differ with one another on exactly what conditions they can and can’t treat.
Long has testified at about 200 trials, performed more than 10,000 chiropractic case evaluations, and served as a consultant to several law enforcement agencies. He is also an associate professor at Bryan University, where he teaches in the master’s program in applied health informatics. What follows is just a half dozen bullet points from a blog he wrote titled, “20 Things Most Chiropractors Won’t Tell You.”(I Bob Aronson selected only the first six points and edited them for brevity) you can read the entire unedited version here http://edzardernst.com/2013/10/twenty-things-most-chiropractors-wont-tell-you/
Have you ever consulted a chiropractor? Are you thinking about seeing one? Do you care whether your tax and health-care dollars are spent on worthless treatment? If your answer to any of these questions is yes, there are certain things you should know.
1. Chiropractic theory and practice are not based on the body of knowledge related to health, disease, and health care that has been widely accepted by the scientific community.
Most chiropractors believe that spinal problems, which they call “subluxations,” cause ill health and that fixing them by “adjusting” the spine will promote and restore health. The extent of this belief varies from chiropractor to chiropractor. Some believe that subluxations are the primary cause of ill health; others consider them an underlying cause. Only a small percentage (including me) reject these notions and align their beliefs and practices with those of the science-based medical community. The ramifications and consequences of subluxation theory will be discussed in detail throughout this book.
2. Many chiropractors promise too much.
The most common forms of treatment administered by chiropractors are spinal manipulation and passive physiotherapy measures such as heat, ultrasound, massage, and electrical muscle stimulation. These modalities can be useful in managing certain problems of muscles and bones, but they have little, if any, use against the vast majority of diseases. But chiropractors who believe that “subluxations” cause ill health claim that spinal adjustments promote general health and enable patients to recover from a wide range of diseases. Some have a hand out that improperly relates “subluxations” to a wide range of ailments that spinal adjustments supposedly can help. Some charts of this type have listed more than 100 diseases and conditions, including allergies, appendicitis, anemia, crossed eyes, deafness, gallbladder problems, hernias, and pneumonia.
3. Our education is vastly inferior to that of medical doctors.
I rarely encountered sick patients in my school clinic. Most of my “patients” were friends, students, and an occasional person who presented to the student clinic for inexpensive chiropractic care. Most had nothing really wrong with them. In order to graduate, chiropractic college students are required to treat a minimum number of people. To reach their number, some resort to paying people (including prostitutes) to visit them at the college’s clinic.
4. Our legitimate scope is actually very narrow.
Appropriate chiropractic treatment is relevant only to a narrow range of ailments, nearly all related to musculoskeletal problems. But some chiropractors assert that they can influence the course of nearly everything. Some even offer adjustments to farm animals and family pets.
5. Very little of what chiropractors do has been studied.
Although chiropractic has been around since 1895, little of what we do meets the scientific standard through solid research. Chiropractic apologists try to sound scientific to counter their detractors, but very little research actually supports what chiropractors do.
6. Unless your diagnosis is obvious, it’s best to get diagnosed elsewhere.
During my work as an independent examiner, I have encountered many patients whose chiropractor missed readily apparent diagnoses and rendered inappropriate treatment for long periods of time. Chiropractors lack the depth of training available to medical doctors. For that reason, except for minor injuries, it is usually better to seek medical diagnosis first.
Obviously the previous report is pretty damning but the author’s views are not universally shared. The problem with finding positive reports about the Chiropractic profession is that there are very few traditional double blind placebo studies. Double blind studies are the “Gold Standard” in medicine. Most of the supporting evidence for Chiropractic medicine is of the testimonial variety otherwise known as “Anecdotal” evidence. Often you will see ads that suggest 9 out of 10 who tried something got relief and while that sounds good, it is anecdotal, not double blind and that’s why Chiropractors are suspect in the eyes of the medical profession, even though Medical Doctors will on occasion for specific ailments send their patients to Chiropractors.
Here’s an evaluation of the top ten Chiropractic studies of 2013…it is not positive because, the author says, the studies were not really studies. http://www.sciencebasedmedicine.org/top-10-chiropractic-studies-of-2013/
So, what about the good side of the profession? Where’s the evidence that Chiropractic manipulation of the spine actually has lasting benefits?
I searched for a long time and the best non anecdotal defense I could find for the Chiropractic profession was in Web MD. You can read all of it here, but note that the endorsement is strictly for back pain. http://www.webmd.com/pain-management/guide/chiropractic-pain-relief
Among people seeking back pain relief alternatives, most choose chiropractic treatment. About 22 million Americans visit chiropractors annually. Of these, 7.7 million, or 35%, are seeking relief from back pain from various causes, including accidents, sports injuries, and muscle strains. Other complaints include pain in the neck, arms, and legs, and headaches.
What Is Chiropractic? ,
Chiropractors use hands-on spinal manipulation and other alternative treatments, the theory being that proper alignment of the body’s musculoskeletal structure, particularly the spine, will enable the body to heal itself without surgery or medication. Manipulation is used to restore mobility to joints restricted by tissue injury caused by a traumatic event, such as falling, or repetitive stress, such as sitting without proper back support.
Chiropractic is primarily used as a pain relief alternative for muscles, joints, bones, and connective tissue, such as cartilage, ligaments, and tendons. It is sometimes used in conjunction with conventional medical treatment.
The initials “DC” identify a chiropractor, whose education typically includes an undergraduate degree plus four years of chiropractic college.
What Does Chiropractic for Back Pain Involve?
A chiropractor first takes a medical history, performs a physical examination, and may use lab tests or diagnostic imaging to determine if treatment is appropriate for your back pain.
The treatment plan may involve one or more manual adjustments in which the doctor manipulates the joints, using a controlled, sudden force to improve range and quality of motion. Many chiropractors also incorporate nutritional counseling and exercise/rehabilitation into the treatment plan. The goals of chiropractic care include the restoration of function and prevention of injury in addition to back pain relief.
What Are the Benefits and Risks of Chiropractic Care?
Spinal manipulation and chiropractic care is generally considered a safe, effective treatment for acute low back pain, the type of sudden injury that results from moving furniture or getting tackled. Acute back pain, which is more common than chronic pain, lasts no more than six weeks and typically gets better on its own.
Research has also shown chiropractic to be helpful in treating neck pain and headaches. In addition, osteoarthritis and fibromyalgia may respond to the moderate pressure used both by chiropractors and practitioners of deep tissue massage.
Studies have not confirmed the effectiveness of prolotherapy or sclerotherapy for pain relief, used by some chiropractors, osteopaths, and medical doctors, to treat chronic back pain, the type of pain that may come on suddenly or gradually and lasts more than three months. The therapy involves injections such as sugar water or anesthetic in hopes of strengthening the ligaments in the back.
People who have osteoporosis, spinal cord compression, or inflammatory arthritis, or who take blood-thinning medications should not undergo spinal manipulation. In addition, patients with a history of cancer should first obtain clearance from their medical doctor before undergoing spinal manipulation.
All treatment is based on an accurate diagnosis of your back pain. The chiropractor should be well informed regarding your medical history, including ongoing medical conditions, current medications, traumatic/surgical history, and lifestyle factors. Although rare, there have been cases in which treatment worsened a herniated or slipped disc, or neck manipulation resulted in stroke or spinal cord injury. To be safe, always inform your primary health care provider whenever you use chiropractic or other pain relief alternatives.
On my OTI Facebook group I asked for individual experiences with chiropractors and got very few, most were positive but general in nature offering few details.
Other Non-Traditional Remedies
There are other non-traditional remedies for back pain that we have not mentioned here. Below you will find several that were listed in “About dot com. “ For the full list of 15 options click on this link. http://altmedicine.about.com/od/chronicpain/a/back_pain.htm
A 2008 study published in Spine found “strong evidence that acupuncture can be a useful supplement to other forms of conventional therapy” for low back pain. After analyzing 23 clinical trials with a total of 6,359 patients, the study authors also found “moderate evidence that acupuncture is more effective than no treatment” in relief of back pain. The authors note that more research is needed before acupuncture can be recommended over conventional therapies for back pain.
Just how does acupuncture work? According totraditional Chinese medicine, pain results from blocked energy along energy pathways of the body, which are unblocked when acupuncture needles are inserted along these invisible pathways. Acupuncture may release natural pain-relieving opioids, send signals to the sympathetic nervous system, and release neurochemicals and hormones.
In a 2009 research review published in Spine, researchers reviewed 13 clinical trials on the use of massage in treatment of back pain. The study authors concluded that massage “might be beneficial for patients with subacute and chronic nonspecific low back pain, especially when combined with exercises and education.” Noting that more research is needed to confirm this conclusion, the authors call for further studies that might help determine whether massage is a cost-effective treatment for low back pain.
Massage therapy may also alleviate anxiety and depression associated with chronic pain. It is the most popular natural therapy for low back pain during pregnancy.
The Alexander Technique
Alexander Technique is a type of therapy that teaches people to improve their posture and eliminate bad habits such as slouching, which can lead to pain, muscle tension, and decreased mobility.
There is strong scientific support for the effectiveness of Alexander Technique lessons in treatment of chronic back pain, according to a research review published in the International Journal of Clinical Practice in 2012. The review included one well-designed, well-conducted clinical trial demonstrating that Alexander Technique lessons led to significant long-term reductions in back pain and incapacity caused by chronic back pain. These results were broadly supported by a smaller, earlier clinical trial testing the use of Alexander Technique lessons in treatment of chronic back pain.
You can learn Alexander technique in private sessions or group classes. A typical session lasts about 45 minutes. During that time, the instructor notes the way you carry yourself and coaches you with verbal instruction and gentle touch.
Also referred to as “hypnosis,” hypnotherapy is a mind-body technique that involves entering a trance-like state of deep relaxation and concentration. When undergoing hypnotherapy, patients are thought to be more open to suggestion. As such, hypnotherapy is often used to effect change in behaviors thought to contribute to health problems (including chronic pain).
Preliminary research suggests that hypnotherapy may be of some use in treatment of low back pain. For instance, a pilot study published in the International Journal of Clinical and Experimental Hypnosis found that a four-session hypnosis program (combined with a psychological education program) significantly reduced pain intensity and led to improvements in mood among patients with chronic low back pain.
One of the oldest therapies for pain relief, balneotherapy is a form of hydrotherapy that involves bathing in mineral water or warm water.
For a 2006 report published in Rheumatology, investigators analyzed the available research on the use of balneotherapy in treatment of low back pain. Looking at five clinical trial, the report’s authors found “encouraging evidence” suggesting that balneotherapy may be effective for treating patients with low back pain. Noting that supporting data are scarce, the authors call for larger-scale trials on balneotherapy and low back pain.
Dead Sea salts and other sulfur-containing bath salts can be found in spas, health food stores, and online. However, people with heart conditions should not use balneotherapy unless under the supervision of their primary care provider.
An ancient mind-body practice, meditation has been found to increase pain tolerance and promote management of chronic pain in a number of small studies. In addition, a number of preliminary studies have focused specifically on the use of meditation in management of low back pain. A 2008 study published in Pain, for example, found that an eight-week meditation program led to an improvement of pain acceptance and physical function in patients with chronic low back pain. The study included 37 older adults, with members meditating an average of 4.3 days a week for an average of 31.6 minutes a day.
Although it’s not known how meditation might help relieve pain, it’s thought that the practice’s ability to induce physical and mental relaxation may help keep chronic stress from aggravating chronic pain conditions.
One of the most commonly practiced and well-studied forms of meditation is mindfulness meditation.
Tai chi is an ancient martial art that involves slow, graceful movements and incorporates meditation and deep breathing. Thought to reduce stress, tai chi has been found to benefit people with chronic pain in a number of small studies.
Although research on the use of tai chi in treatment of back pain is somewhat limited, there’s some evidence that practicing tai chi may help alleviate back pain to some degree. The available science includes a 2011 study published in Arthritis Care & Research, which found that a 10-week tai chi program reduced pain and improved functioning in people with long-term low back pain symptoms. The study involved 160 adults with chronic low back pain, half of whom participated in 40-minute-long tai chi sessions 18 times over the 10-week period.
Music therapy is a low-cost natural therapy that may reduce some of the stress of chronic pain in conjunction with other treatment. Studies find that it may reduce the disability, anxiety, and depression associated with chronic pain.
A 2005 study published in Annals of Physical and Rehabilitation Medicine evaluated the influence of music therapy in hospitalized patients with chronic back pain. Researchers randomized 65 patients to receive, on alternate months, physical therapy plus four music therapy sessions or physical therapy alone and found that music significantly reduced disability, anxiety, and depression
It is difficult at best to arrive at a conclusion about the effectiveness of Chiropractic manipulation for two reasons. 1) there are very few real scientific studies and 2) The members of the profession don’t even seem to agree on just when and on which conditions Chiropractors can offer lasting relief. I can only conclude with this thought. At one time Chiropractors were ridiculed by the medical profession and not covered by health insurance. Now, that has changed and the profession seems to be enjoying a degree of legitimacy It has never before had.
If you will take anecdotal evidence as scientific proof then Chiropractors are very effective. If you prefer to make a decision based on scientific studies…well, the jury may still be out.
The bottom line is quite simple. If you have been to a Chiropractor and the visit or visits have resulted in relief from what ails you, then keep going. You are the best judge of what’s right for you.
Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 4,000 member Organ Transplant Initiative (OTI) and the author of most of these donation/transplantation blogs. You may comment in the space provided or email your thoughts to me at firstname.lastname@example.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.
By Bob Aronson
When your life has been saved in hospitals several times as mine has, it is difficult to write a blog that is critical of those institutions but, it is just as difficult to ignore the facts. As a writer who has made a commitment to provide accurate and timely information to his readers it would be irresponsible to do so.
This blog is about and for pre and post-transplant patients, their families, donors, donor families, caregivers and friends. Those of us who are awaiting transplants or who have had them spend an inordinate amount of time in hospitals and clinics. Our compromised immune systems make us far more susceptible to a myriad of diseases and problems than the average patient and that means we have to be more alert and aware of our surroundings. It is for that reason that I am posting this information.
I did not make up the numbers you are about to read. They are available for everyone to see and to analyze through the links I have provided. Your comments are not only welcome, they are encouraged.
Never Events, Hospital Acquired Conditions and Sentinel Events
Heart disease and cancer are the number one and two causes of death in the United States. Number three is medical errors. The very people who are supposed to be experts in saving lives are also responsible for thousands of deaths.
Medical errors in hospitals are killing us faster than chronic lower respiratory diseases, stroke (cerebrovascular diseases), accidents of all kinds, Alzheimer’s disease and diabetes combined. The very people we trust our lives to – are not only contributing to our deaths they don’t seem to be learning from their mistakes because the problem appears to be getting worse. While many hospitals claim they are making progress the national numbers don’t show it. The evidence to the contrary is overwhelming. And — one cannot help but believe that the problem is even worse than is stated in this posting because there is no system in the U.S. for reporting and tracking medical errors and their results. Voluntary reporting is spotty and incomplete so we are left with educated guestimates and they are frightening.
In 1999, the Institute of Medicine published the “To Err Is Human” report. It generated huge front page headlines everywhere by estimating that nearly 100,000 people die every year as a result of hospital errors. At first there was widespread denial in the medical community but no longer. The medical profession accepts that number. The problem is that the number is wrong.
In 2010 another number was announced. The Office of the U.S. Inspector General for Health and Human Services said that poor hospital care contributed to the deaths of 180,000 patients in Medicare alone in any given year… Note — they said Medicare alone! But — that number is wrong, too. The story is about to get much worse.
A study published in September of 2013 in the Journal of Patient Safety says the numbers may be much higher. They say that between 210,000 and 440,000 patients die in hospitals each year as the result of preventable errors. Please note that the numbers quoted in the preceding reports only refer to deaths. None of the numbers I have seen say anything about the number of injuries caused by medical errors.
The new estimates were the result of work by John T. James, who works as a toxicologist at NASA’s Houston, Texas space center. James also runs a group called Patient Safety America. http://patientsafetyamerica.com/ James dedicated the site to his 19-year old son, John Alexander James, who he says, “Died as a result of uninformed, careless, and unethical care by cardiologists at a hospital in central Texas in the late summer of 2002.”
ProPublica an investigative journalism group asked three prominent patient safety researchers to review James’ study and all said his methods and findings were credible. http://www.propublica.org/ The American Hospital Association, though, rejects the number preferring to believe the number of 98,000 deaths from the 1999 report.
What’s the right number? Nobody knows for sure but we do know it is not getting smaller. As stated earlier there is no standardized national reporting system on medical errors, who is affected and who makes them.
So we’re left with approximations, which are imperfect in part because of inaccuracies in medical records and the fact that a good many of the errors that take place are never reported. Hospitals and physicians have traditionally fought establishing a formal reporting system for fear of prosecution. Instead they advocate a voluntary reporting system which begs the question, “Who is going to voluntarily admit to committing an error that resulted in a patient’s injury or death.” I have to believe the number would be quite small. Admissions of that nature could have extremely negative effects on careers and may even open the door to civil suits or criminal prosecution. Perhaps I can be persuaded to think otherwise but I’ve seen nothing so far to indicate any voluntary system can work.
While the lay public calls them medical mistakes or errors the medical community has chosen to use different terminology. They refer to their errors as “Never Events” or Hospital Acquired Conditions (HACs) Never events are never supposed to happen – but they do and the onus is clearly on hospitals to do something about them. The Government found that one way to force hospitals to deal with these problems is to refuse payment so for several years now Medicaid and Medicare do not pay for any Hospital Acquired Condition.
When I was a communications consultant I specialized in health care so I spent a great deal of time working in and around hospitals and clinics. The great majority of them take the issue of patient safety very seriously and have implemented a multitude of actions to address the problem. They all have preventive programs and systems on what to do when there is an error. Most hospitals conduct a “Root Cause Analysis” every time there is a significant error so they can be sure the same error doesn’t happen again. They are working on the problem but patients owe it to themselves to always be alert and to question everything. Hospitals need to know that we are watching very carefully and that we will report what we see and experience.
Here is a list of HACs or Never Events as prepared by the National Quality Forum (NQF).
|Table. Never Events or Hospital Acquired Conditions
|Surgery or other invasive procedure performed on the wrong body part|
|Surgery or other invasive procedure performed on the wrong patient|
|Wrong surgical or other invasive procedure performed on a patient|
|Unintended retention of a foreign object in a patient after surgery or other procedure|
|Intraoperative or immediately postoperative/post procedure death in an American Society of Anesthesiologists Class I patient|
|Product or device events|
|Patient death or serious injury associated with the use of contaminated drugs, devices, or biologics provided by the health care setting|
|Patient death or serious injury associated with the use or function of a device in patient care, in which the device is used for functions other than as intended|
|Patient death or serious injury associated with intravascular air embolism that occurs while being cared for in a health care setting|
|Patient protection events|
|Discharge or release of a patient/resident of any age, who is unable to make decisions, to other than an authorized person|
|Patient death or serious disability associated with patient elopement (disappearance)|
|Patient suicide, attempted suicide, or self-harm resulting in serious disability, while being cared for in a health care facility|
|Care management events|
|Patient death or serious injury associated with a medication error (e.g., errors involving the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation, or wrong route of administration)|
|Patient death or serious injury associated with unsafe administration of blood products|
|Maternal death or serious injury associated with labor or delivery in a low-risk pregnancy while being cared for in a health care setting|
|Death or serious injury of a neonate associated with labor or delivery in a low-risk pregnancy|
|Artificial insemination with the wrong donor sperm or wrong egg|
|Patient death or serious injury associated with a fall while being cared for in a health care setting|
|Any stage 3, stage 4, or unstageable pressure ulcers acquired after admission/presentation to a health care facility|
|Patient death or serious disability resulting from the irretrievable loss of an irreplaceable biological specimen|
|Patient death or serious injury resulting from failure to follow up or communicate laboratory, pathology, or radiology test results|
|Patient or staff death or serious disability associated with an electric shock in the course of a patient care process in a health care setting|
|Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains no gas, the wrong gas, or is contaminated by toxic substances|
|Patient or staff death or serious injury associated with a burn incurred from any source in the course of a patient care process in a health care setting|
|Patient death or serious injury associated with the use of restraints or bedrails while being cared for in a health care setting|
|Death or serious injury of a patient or staff associated with introduction of a metallic object into the MRI area|
|Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed health care provider|
|Abduction of a patient/resident of any age|
|Sexual abuse/assault on a patient within or on the grounds of a health care setting|
|Death or significant injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs within or on the grounds of a health care setting|
Real Life Examples of Medical Mistakes
- Wrong Heart and Lung Transplant. One of the most tragic medical blunders ever took place at Duke University medical center in 2003, when surgeons transplanted a heart lung combination with the wrong blood type into 17-year-old Jesica Santillan. Her body began to shut down almost immediately. The hospital somehow secured a second and proper matched heart lung combination for Jessica but it was too late and she died. Dr. James Jaggers accepted responsibility for the tragic mistake, and Duke along with most other hospitals now have systems that require double checking the blood and tissue matches for transplants.
- Souvenir of surgery. In the year 2000 49 year old Donald Church had an abdominal tumor removed at the U of Washington Medical center in Seattle. While he left the hospital without the tumor, he had something that he didn’t have on admission — a 13-inch-long retractor had been left in Church’s abdomen by mistake. To make matters worse it was a repeat performance for the hospital, four other such occurrences had been documented there between 1997 and 2000. Fortunately, surgeons were able to remove the instrument but also agreed to pay Church nearly $100,000.
- Healthy kidney removed. Park Nicollet Methodist Hospital in Minnesota’s twin cities was the site of the next never event. A man was admitted to have one of his kidneys removed due to a cancerous tumor. Surgeons did just that but upon a post-surgical examination of the removed kidney they found no malignancy. That’s when they discovered they had removed the wrong one. We can’t report further because the family involved requested anonymity but Park Nicollet publicly admitted the error.
What Patients Can Do
The cable network developed this list of what they call “10 Shocking Medical Mistakes and Ways to Not Become a Victim.
1. Mistake: Treating the wrong patient
• Cause: Hospital staff fails to verify a patient’s identity.
• Consequences: Patients with similar names are confused.
• Prevention: Before every procedure in the hospital, make sure the staff checks your entire name, date of birth and barcode on your wrist band.
2. Mistake: Surgical souvenirs
• Cause: Surgical staff miscounts (or fails to count) equipment used inside a patient during an operation.
• Consequences: Tools get left inside the body.
• Prevention: If you have unexpected pain, fever or swelling after surgery, ask if you might have a surgical instrument inside you.
3. Mistake: Lost patients
• Cause: Patients with dementia are sometimes prone to wandering.
• Consequences: Patients may become trapped while wandering and die from hypothermia or dehydration.
• Prevention: If your loved one sometimes wanders, consider a GPS tracking bracelet.
4. Mistake: Fake doctors
• Cause: Con artists pretend to be doctors.
• Consequences: Medical treatments backfire. Instead of getting better, patients get sicker.
• Prevention: Confirm online that your physician is licensed.
5. Mistake: The ER waiting game
• Cause: Emergency rooms get backed up when overcrowded hospitals don’t have enough beds.
• Consequences: Patients get sicker while waiting for care.
• Prevention: Doctors listen to other doctors, so on your way to the hospital call your physician and ask them to call the emergency room.
6. Mistake: Air bubbles in blood
• Cause: The hole in a patient’s chest isn’t sealed airtight after a chest tube is removed.
• Consequences: Air bubbles get sucked into the wound and cut off blood supply to the patient’s lungs, heart, kidneys and brain. Left uncorrected the patient dies.
• Prevention: If you have a central line tube in you, ask how you should be positioned when the line comes out.
7. Mistake: Operating on the wrong body part
• Cause: A patient’s chart is incorrect, or a surgeon misreads it, or surgical draping obscures marks that denote the correct side of the operation.
• Consequences: The surgeon cuts into the wrong side of a patient’s body.
• Prevention: Just before surgery, make sure you reaffirm with the nurse and the surgeon the correct body part and side of your operation.
8. Mistake: Infection infestation
• Cause: Doctors and nurses don’t wash their hands.
• Consequences: Patients can die from infections spread by hospital workers.
• Prevention: It may be uncomfortable to ask, but make sure doctors and nurses wash their hands before they touch you, even if they’re wearing gloves.
9. Mistake: Lookalike tubes
• Cause: A chest tube and a feeding tube can look a lot alike.
• Consequences: Medicine meant for the stomach goes into the chest.
• Prevention: When you have tubes in you, ask the staff to trace every tube back to the point of origin so the right medicine goes to the right place.
10. Mistake: Waking up during surgery
• Cause: An under-dose of anesthesia.
• Consequences: The brain stays awake while the muscles stay frozen. Most patients aren’t in any pain but some feel every poke, prod and cut.
• Prevention: When you schedule surgery, ask your surgeon if you need to be put asleep or if a local anesthetic might work just as well.
There are other steps you can take to protect yourself besides those offered by CNN. For example:
Demand a hand-wash. While hospitals try to be germ free it is hard when almost everyone who enters the building is sick. It is a well-known fact that the best thing people can do to protect themselves from disease is frequent hand washing. The potential for contamination is everywhere so you are well within your rights to ask personnel to wash their hands before touching you. And…by the way, wash your hands frequently too.
Make sure your room is clean. Usually hospital rooms are thoroughly washed between patients but not as thoroughly if you are going to be there for a while. If you are concerned with the state of your room ask for certain areas or all of it to be disinfected. Transplant recipients in particular must be sure they are in as germ free an environment as possible. Certainly if hospitalized they should always wear a face mask to protect themselves. And, do your best to stay out of crowded areas like elevators. If you must enter a crowded room, wear a face mask. All hospitals have them you just have to ask for one…
To be even more specific though, Patient Safety America suggestions these you do the following to stay safe http://patientsafetyamerica.com/truth-about-healthcare/
1. The single most important way you can help to prevent errors is to be an active member of your health care team.
That means taking part in every decision about your health care. Research shows that patients who are more involved with their care tend to get better results. Here are some specific tips, based on the latest scientific evidence about what works best.
2. Make sure that all of your doctors know about everything you are taking. This includes prescription and over-the-counter medicines, and dietary supplements such as vitamins and herbs.
At least once a year, bring all of your medicines and supplements with you to your doctor. “Brown bagging” your medicines can help you and your doctor talk about them and find out if there are any problems. It can also help your doctor keep your records up to date, which can help you get better quality care.
3. Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.
This can help you avoid getting a medicine that can harm you.
4. When your doctor writes you a prescription, make sure you can read it.
If you can’t read your doctor’s handwriting, your pharmacist might not be able to either.
5. Ask for information about your medicines in terms you can understand—both when your medicines are prescribed and when you receive them.
- What is the medicine for?
- How am I supposed to take it, and for how long?
- What side effects are likely? What do I do if they occur?
- Is this medicine safe to take with other medicines or dietary supplements I am taking?
- What food, drink, or activities should I avoid while taking this medicine?
6. When you pick up your medicine from the pharmacy, ask: Is this the medicine that my doctor prescribed?
A study by the Massachusetts College of Pharmacy and Allied Health Sciences found that 88 percent of medicine errors involved the wrong drug or the wrong dose.
7. If you have any questions about the directions on your medicine labels, ask.
Medicine labels can be hard to understand. For example, ask if “four doses daily” means taking a dose every 6 hours around the clock or just during regular waking hours.
8. Ask your pharmacist for the best device to measure your liquid medicine. Also, ask questions if you’re not sure how to use it.
Research shows that many people do not understand the right way to measure liquid medicines. For example, many use household teaspoons, which often do not hold a true teaspoon of liquid. Special devices, like marked syringes, help people to measure the right dose. Being told how to use the devices helps even more.
9. Ask for written information about the side effects your medicine could cause.
If you know what might happen, you will be better prepared if it does—or, if something unexpected happens instead. That way, you can report the problem right away and get help before it gets worse. A study found that written information about medicines can help patients recognize problem side effects and then give that information to their doctor or pharmacist.
10. If you have a choice, choose a hospital at which many patients have the procedure or surgery you need.
Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.
11. If you are in a hospital, consider asking all health care workers who have direct contact with you whether they have washed their hands.
Hand washing is an important way to prevent the spread of infections in hospitals. Yet, it is not done regularly or thoroughly enough. A recent study found that when patients checked whether health care workers washed their hands, the workers washed their hands more often and used more soap.
12. When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will use at home.
This includes learning about your medicines and finding out when you can get back to your regular activities. Research shows that at discharge time, doctors think their patients understand more than they really do about what they should or should not do when they return home.
13. If you are having surgery, make sure that you, your doctor, and your surgeon all agree and are clear on exactly what will be done.
Doing surgery at the wrong site (for example, operating on the left knee instead of the right) is rare. But even once is too often. The good news is that wrong-site surgery is 100 percent preventable. The American Academy of Orthopedic Surgeons urges its members to sign their initials directly on the site to be operated on before the surgery.
Other Steps You Can Take
14. Speak up if you have questions or concerns.
You have a right to question anyone who is involved with your care.
15. Make sure that someone, such as your personal doctor, is in charge of your care.
This is especially important if you have many health problems or are in a hospital.
16. Make sure that all health professionals involved in your care have important health information about you.
Do not assume that everyone knows everything they need to.
17. Ask a family member or friend to be there with you and to be your advocate (someone who can help get things done and speak up for you if you can’t).
Even if you think you don’t need help now, you might need it later.
18. Know that “more” is not always better.
It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.
19. If you have a test, don’t assume that no news is good news.
Ask about the results.
20. Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources.
You may ask yourself upon reading all of this what the U.S. Food and Drug Administration (FDA) is doing to make hospitals safer. Well, they can’t be in every hospital all the time to watch everything and…that’s not their role. The FDA is probably not doing enough to protect us, there’s no way you can satisfy everyone but they are doing a few things that could make a huge difference. One of which is to eliminate drug name confusion.
To minimize confusion between drug names that look or sound alike, the FDA reviews about 300 drug names a year before they are marketed. “About one-third of the names that drug companies propose are rejected,” says Phillips. The agency tests drug names with the help of about 120 FDA health professionals who volunteer to simulate real-life drug order situations. “FDA also created a computerized program that assists in detecting similar names and that will help take a more scientific approach to comparing names,” Phillips says.
After drugs are approved, the FDA tracks reports of errors due to drug name confusion and spreads the word to health professionals, along with recommendations for avoiding future problems. For example, the FDA has reported errors involving the inadvertent administration of methadone, a drug used to treat opiate dependence, rather than the intended Metadate ER (methylphenidate) for the treatment of attention-deficit/hyperactivity disorder (ADHD). One report involved the death of an 8-year-old boy after a possible medication error at the dispensing pharmacy. The child, who was being treated for ADHD, was found dead at home. Methadone substitution was the suspected cause of death. Some FDA recommendations regarding drug name confusion have encouraged pharmacists to separate similar drug products on pharmacy shelves and have encouraged physicians to indicate both brand and generic drug names on prescription orders, as well as what the drug is intended to treat.
The last time the FDA changed a drug name after it was approved was in 2004 when the cholesterol-lowering medicine Altocor was being confused with the cholesterol-lowering medicine Advicor. Now Altocor is called Altoprev, and the agency hasn’t received reports of errors since the name change. Other examples of drug name confusion reported to the FDA include:
- Serzone (nefazodone) for depression and Seroquel (quetiapine) for schizophrenia
- Lamictal (lamotrigine) for epilepsy, Lamisil (terbinafine) for nail infections, Ludiomil (maprotiline) for depression, and Lomotil (diphenoxylate) for diarrhea
- Taxotere (docetaxel) and Taxol (paclitaxel), both for chemotherapy
- Zantac (ranitidine) for heartburn, Zyrtec (cetirizine) for allergies, and Zyprexa (olanzapine) for mental conditions
- Celebrex (celecoxib) for arthritis and Celexa (citalopram) for depression.
For more information on the FDA and what they are doing click on this link http://www.fda.gov/
The bottom line on medical errors is activist patients. Don’t sit by quietly when you perceive something to be wrong with your care or the care of someone near and dear to you. Speak up, tell someone about your concerns. Every city and state has some sort of health department so if you see something wrong speak up and tell the appropriate authority starting with the hospital.
Most importantly, though, be aggressive and knowledgeable about your own health care. Don’t be afraid to ask for second opinions, to question physicians, nurses and other practitioners. Force your health care provider to speak to you in plain English and if you don’t understand ask for clarification. Hospital personnel work for you so they have a responsibility to respond to your concerns in as thorough and clear a manner as possible. The only way hospitals will really change for the better is for citizens, patients like you and me to speak up and let them know we know.
Now retired and living in Jacksonville, Florida with his wife Robin he spends his time advocating for patients with end stage diseases and for organ recipients. He is also active in helping his wife with her art business at art festivals and on her Rockin Robin Prints site on Etsy.
Bob is a former journalist, Governor’s Communication Director and international communications consultant.
From time to time we hear of a non-U.S. citizen getting an organ transplant at an American medical center having received the organ from the American donor pool. Is that proper? There’s more of it going on than you may suspect and transplant centers don’t talk about it much.
While I am the first to admit that my research of this topic is inadequate it still raises legitimate questions. Why do we allow non-U.S. citizens to get transplants here? Shouldn’t American organs go to Americans? Should donors be able to designate that they only want their organs to go to fellow citizens?
No one has made much of a fuss about our organs going to citizens of other countries until the Los Angeles Times investigative report in 2008 uncovered the story of four Japanese gangsters who got liver transplants at the University of California, Los Angeles Medical Center. That story put a burr under a lot of American Saddles but it still took the United Network For Organ Sharing (UNOS), which often moves at breakneck glacier speed, four years to decide to do something about it. Just this year they decided that transplants involving recipients who are not U.S. citizens or residents will get closer scrutiny according to American Medical news” http://www.ama-assn.org/amednews/2012/07/16/prse0718.htm
“Under the policy adopted by the UNOS board of directors in late June, any transplant involving a recipient who is not a U.S. citizen or resident can be reviewed by the Organ Procurement and Transplantation Network (OPTN).
Transplant centers will have to provide data to the OPTN. That information will include a recipient’s country of origin, the reason for seeking transplantation in the U.S. and how the procedure is being financed. Data on transplantation by citizenship status will be publicly reported.
Centers will be barred from entering contracts with foreign agencies or governments to provide transplantation services. Transplant centers must abide by OPTN/UNOS rules in order to be paid by Medicare.”
I don’t know about you, readers, but this report doesn’t really tell me what a review by OPTN could result in. Like…could they deny the transplant?
Later in this post you will see more specifics but in the decade from 2000 through 2010 685 non-U.S. citizens got organ transplants here with organs coming from American donors. What is bothersome to me is that when we sign up to be donors I think we do so assuming that our organs will go to fellow citizens. That apparently is not always the case.
When you consider that about 20 U.S. Citizens die every day because there are not enough organs is it right that a rich foreigner (the great majority pay cash) can come here and take an organ that might otherwise have gone to one of us? Why is there a rule that American Transplant Centers can list foreigners but they can make up no more than 5% of any center’s list? And — is it true that some organs are given to illegal aliens? We’ll attempt to answer those questions and more in this post.
Before we more completely address these important questions it is important to frame the issue of organ allocation and transplantation in the United States. As much as we dislike the idea the fact is that we must ration human organs. The gap between available organs and those who need them is so incredibly wide someone has to decide who does and doesn’t get them.
The most burning of questions in organ transplantation is this one; Who on the waiting lists should get transplants first: patients in the greatest need or those most likely to benefit? Example. If a choice has to be made between a 72 year old man has been diagnosed as almost immediately terminal unless he gets an heart transplant and a sick but much healthier 35 year old mother of three; who should get the heart? It could be logically argued that the mother should get it because while not as sick as the man she is more likely to live much, much longer and therefore benefit the most.
As of this writing there are 116,835 candidates on the U.S. transplant waiting list. From January through October of 2012 there were only 23,363 transplants done with the organs coming from 11,659 people. It is obvious with virtually no study of the numbers that the gap between available organs and those who need them is monstrous. And…think about this. In those ten months from January through October of all the people who died in this country only 11,659 of them were acceptable donors (acceptable meaning among registered donors this number had organs healthy enough to be transplanted).
Determining who gets an available organ is not easy and the process is said to be “Blind” meaning patient conditions, age and other medical factors are known but not names or social status. It is important to understand, too, that there are over 150 transplant centers in the United States (complete list here http://tinyurl.com/78qfesx) and each is allowed to decide which of their patients is placed on the national listing. Where there are general guidelines on who can be listed, there is no uniformity which has resulted in each transplant center developing their own criteria for adding patients to the ever growing number.
So how do you get on the transplant list anyway? Well, to start you have to have a Doctor who thinks you are sick enough to be referred to a transplant center, but there are many factors involved one of which is what bioethicist Art Caplan calls the “Wallet biopsy.” You have to prove that you can pay not only for the procedure but the follow-up care and the anti-rejection drugs you must take for the rest of your life. Those drugs can be very expensive…in excess of $1,000 a month..
Even if patients have enough money to qualify for a transplant, the transplant center must also deem them good candidates psychologically and socially and the criteria vary widely. Among the factors that transplant centers weigh as contraindications are not having a spouse or relative or close friend as a caregiver, having suffered a recent death or loss of someone close to you, having a history of criminal behavior or mental illness like schizophrenia or depression, a history of alcoholism or drug dependency, having attempted suicide, having a personality disorder and mental retardation.
With all those qualifications it is the first one, the ability to pay, that may determine your success in getting listed and then getting an organ. So when foreigners come to the U.S. with a boatload of cash it is possible that some transplant centers will make every effort to accommodate their needs including manipulating numbers so that they stay within the 5% restriction.
But…let’s look at the 5%. The number only indicates a limit on foreign transplants it does not say that 5% of all transplants go to foreigners and with the New UNOS rules the number of foreign transplants could diminish. My research on this subject revealed that from 2000 through 2010, 685 non-citizen, non-residents (aka foreign nationals) were given deceased donor kidney transplants in the US. http://livingdonorsarepeopletoo.com/kidneys-given-to-non-us-citizens-non-residents-2000-2010/
Now what about that question on illegal immigrants getting tax paid organ transplants in the U.S.? Research indicates that while it has happened it is rare and in the case of a 2012 kidney transplant at Loyola University in Chicago the transplant was funded by Loyola. http://articles.chicagotribune.com/2012-12-09/news/ct-met-illegal-immigrant-kidney-transplant-20121209_1_illegal-immigrant-kidney-transplant-liver-transplant. Now, one could argue that Loyola money is private money but at the same time the school certainly receives tax dollars for a myriad of uses so the use of tax dollars, however tangential, is certainly possible. More importantly, though, it is clear that an American donor’s organ was given to an illegal alien meaning that an American Citizen did not get it. To me…that’s just not right.
I find it disgraceful that any American citizen should be denied an organ transplant for any reason but to be denied an organ because it went to someone from another country just doesn’t seem right. I did a considerable amount of “googleing” to find a satisfactory explanation for the practice and came up empty handed. Having been on a list and knowing of the shortage scared me. Had known that someone from another country might get an American organ before I did, would have terrified and enraged me. I just don’t think its right.
Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 2,500 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.
You may comment in the space provided or email your thoughts to me at email@example.com. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.
Please view our video “Thank You From the Bottom of my Donor’s heart” on http://www.organti.org This video was produced to promote organ donation so it is free and no permission is needed for its use.
If you want to spread the word personally about organ donation, we have another PowerPoint slide show for your use free and without permission. Just go to http://www.organti.org and click on “Life Pass It On” on the left side of the screen and then just follow the directions. This is NOT a stand-alone show; it needs a presenter but is professionally produced and factually sound. If you decide to use the show I will send you a free copy of my e-book, “How to Get a Standing “O” that will help you with presentation skills. Just write to firstname.lastname@example.org and usually you will get a copy the same day.
Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative The more members we get the greater our clout with decision makers.
Bob’s Newheart and our Facebook group Organ Transplant Initiative (OTI) support and encourage organ donation and potential biological and mechanical alternatives we also believe that the best solution for the organ shortage is to reduce the demand.
Tobacco products along with alcohol are two of the greatest contributors to organ damage and the need for transplants. If we could get people to stop using those substances the demand for transplants would diminish significantly and that could mean that the supply of organs just might catch up to the reduced demand.
The affect of tobacco products on human organs is devastating. There is almost no part of our bodies that the thousands of chemicals in tobacco and cigarette smoke can’t invade and ultimately destroy. If you smoke, it likely will kill you! If you quit your body will begin to recover and the cancers and other diseases will have to find a different host.
Our governments (city, county, state and federal) all tax tobacco often with the intention of using the revenue to finance stop smoking campaigns and most often some of the money collected is used for that purpose but not always. As is usually the case when there is a pot of money available, lots of good causes want some of it, sometimes not so good causes get it so less than 3% of tobacco tax dollars go into anti smoking or smoking cessation programs. Furthermore, settlements in and out of court in the 1990s mean that the tobacco industry is paying states nearly $250 billion over 25 years. Under the agreement, those payments to states will continue flowing even beyond 25 years as long as the tobacco industry is healthy. But the payments would phase out as cigarette company profits decline and would ultimately disappear if people stop smoking. So while government must try to get people to quit smoking, they really don’t want to try too hard.
So, having given you some critical information about smoking I’m hoping you will do two things, 1) if you smoke…quit. 2) tell your elected officials to get really serious about helping people who use tobacco products to quit using them, I submit this post for your consideration and comment.
There’s an adage that goes, ”If you borrow a hundred dollars from the bank, you owe the bank. If you borrow a million you own the bank.” That simply means the bank can’t be too hard on you if they want to get their money back. That’s the situation governments find themselves in with tobacco. In a strange twist, tobacco companies own the government. Let me explain.
Tobacco Kills. Cigarettes alone kill nearly a half million Americans every year. That’s just a cold hard fact. You probably don’t need reminding but I will anyway via the enters for Disease Control in Atlanta, Georgia. They list these facts: http://tinyurl.com/lblldw
- The adverse health effects from cigarette smoking account for an estimated 443,000 deaths, or nearly one of every five deaths, each year in the United States.
- More deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.
- Smoking causes an estimated 90% of all lung cancer deaths in men and 80% of all lung cancer deaths in women.
- An estimated 90% of all deaths from chronic obstructive lung disease are caused by smoking.
Smoking and Increased Health Risks
Compared with nonsmokers, smoking is estimated to increase the risk of—
- coronary heart disease by 2 to 4 times,
- stroke by 2 to 4 times,
- men developing lung cancer by 23 times,
- women developing lung cancer by 13 times, and
- dying from chronic obstructive lung diseases (such as chronic bronchitis and emphysema) by 12 to 13 times.
If trends continue, one billion people will die from tobacco use and exposure during the 21st century – one person every six seconds. Globally, tobacco-related deaths have nearly tripled in the past decade, and tobacco is responsible for more than 15% of all male deaths and 7% of female deaths. Tobacco is also a risk factor for the four leading noncommunicable diseases (NCDs) – cancer, heart disease, diabetes and chronic respiratory diseases – which account for more than 63% of global deaths according to the World Health Organization.
Tobacco use is the number one killer in China, causing 1.2 million deaths annually; this is expected to rise to 3.5 million deaths annually by the year 2030. Tobacco is also responsible for the greatest proportion of male deaths in Turkey (38%) and Kazakhstan (35%), and the greatest proportion of female deaths in the Maldives (25%) and the United States (23%).
Uniquely among cancer-causing agents, however, tobacco is a man-made problem that is completely preventable through proven public policies. Effective measures include tobacco taxes, advertising bans, smoke-free public places, mass media campaigns and effective health warnings. These cost-effective policies are among those included in the World Health Organization’s Framework Convention on Tobacco Control (WHO FCTC), a global treaty endorsed by more than 174 countries, and recommended by the World Health Organization in its MPOWER policy package. http://tinyurl.com/bor7897
Our government knows all of this. All of our elected officials know this and they all publicly support anti-smoking efforts. They go to great extremes to condemn the use of tobacco while explaining the public health consequences. Almost no one is pro smoking and yet everyone is pro smoking because we have come to depend on the billions of tax dollars generated by the sale of tobacco products. It should be pointed out that at least the U.S,. Government no longer subsidizes tobacco farmers. That program ended several years ago.
As usual the poor are hit the hardest by the addictive nature of tobacco. In a study conducted on behalf of the New York State Department of Health, it revealed that low-income smokers (those in households making under $30,000), spent an average of 23.6% of their annual household income on cigarettes, compared to 2.2% for smokers in households making over $60,000.
Taxes on tobacco products total billions of dollars a year. An example — in New York state the federal tax on a package of 20 cigarettes is $1.01, the state tax is $4.35. New York City adds a local tax of $1.50 to the state levy. That brings the combined tax rate on a package of 20 cigarettes in New York City to $6.36. Tobacco manufacturers add their profit on top of that so depending on where you buy your cigarettes in the city you could pay as much as $12 a pack…twelve dollars for a pack of cigarettes. By comparison, when I started smoking in 1954 you could buy a pack of “Wings” cigarettes for Ten cents. Major brands like Lucky Strikes or Camels were a quarter (quit smoking in 1991).
Tobacco Industry Profits Greater Than Ever
According to The Tobacco Atlas, estimates of revenues from the global tobacco industry likely approach a half trillion U.S. dollars annually. In 2010, the combined profits of the six leading tobacco companies was U.S. $35.1 billion, equal to the combined profits of Coca-Cola, Microsoft, and McDonald’s in the same year. If Big Tobacco were a country, it would have a gross domestic product (GDP) of countries like Poland, Saudi Arabia, Sweden and Venezuela.
In the meantime, tobacco companies are fighting laws with every weapon in their arsenal because just as their product kills people, restrictive smoking laws can kill the industry, a killing some say, is necessary and justified homicide.
As countries around the world ramp up their campaigns against smoking with tough restrictions on tobacco advertising, the industry is fighting back by invoking international trade agreements to thwart the most stringent rules.
A key battlefront is Australia, which is trying to repel a legal assault on its groundbreaking law requiring cigarettes to be sold in plain packs without distinctive brand logos or colors. Contesting the law, which takes effect Dec. 1, are the top multinational cigarette makers and three countries — Ukraine, Honduras and Dominican Republic — whose legal fees are being paid by the industry. http://tinyurl.com/chypao4
Tobacco use has diminished considerably in most of the developed countries but not all of them. The leafy crop is gaining new popularity among U.S. farmers. Cheaper U.S. tobacco has become competitive as an export, and China, Russia and Mexico, where cigarette sales continue to grow, are eager to buy. Since 2005, U.S. tobacco acreage has risen 20 percent. Fields are now filled with it in places like southern Illinois, which hasn’t grown any substantial amounts since the end of World War I. http://www.freerepublic.com/focus/f-news/1899911/posts
While the price of cigarettes has continuously increased since 1965, the percentage of that price going towards taxes is now half of what it was then. ]While tobacco companies complain about the $1.01 cigarette tax, Phillip Morris, Reynolds American, and Lorillard have all increased their prices by almost $1.00 per pack on their own. Phillip Morris currently lists all taxes, including federal, state, local, and sales taxes, as 56.6% of the total cost of a pack of cigarettes.
One of the reasons for the support of increased cigarette taxes among public health officials is that many studies show that this leads to a decrease in smoking rates. The relationship between smoking rates and cigarette taxes is in fact very elastic; the greater the amount of the tax increase, the greater the proportion of smokers who stop smoking. This is especially prevalent amongst teenagers. For every ten percent increase in the price of a pack of cigarettes, youth smoking rates overall drop about seven percent. This rate is also true amongst minorities and low income population smokers. The rates of calls to quitting hot-lines are directly related to cigarette tax hikes. When Wisconsin raised its state cigarette tax to $1.00 per pack, the hot-line received a record of 20,000 calls in a two month time period versus its typical 9,000 calls annually.
According to the New York Times taxes are not the only government revenue from cigarettes. Settlements in the late 1990s to end state lawsuits against tobacco companies mean that the cigarette industry is paying states nearly $250 billion over 25 years. Under the agreement, those payments to states will continue flowing even beyond 25 years as long as the tobacco industry is healthy. But the payments would phase out as cigarette company profits decline and would ultimately disappear if people stop smoking.
So the government has become a financial stakeholder in smoking, some would argue, even as public health officials warn people about its deadly consequences. Smoking declines as cigarette taxes increase, but a core group of smokers hang on to the habit. http://www.nytimes.com/2008/08/31/weekinreview/31saul.html
Will the government or governments ever really crack down on smoking? Doubtful, there is too much money in it for them so the tobacco companies and the politicians who seek to eradicate them have come to be bedfellows. What many politicians fail to see is the savings that could be had if people didn’t smoke. According to the CDC again, “Smoking is also a major contributor to many chronic diseases that are driving up the nation’s health care costs. Each year, diseases caused by cigarette smoking result in $96 billion in health care costs, much of which is paid by taxpayers through publicly-funded health programs.” http://www.cdc.gov/features/TobaccoControlData/ but the savings go beyond that when you consider the costs to employers and employees in higher premiums and lost work time due to tobacco caused illnesses.
If we truly wanted to wipe out smoking, taxes could be raised even higher than they are and the dollars generated could go a long way toward helping to solve our budget problems. Unfortunately if everyone quit smoking, the tax revenue would disappear, too and therein lies the dilemma, but it does prove that you can be both for and against something at the same time.
The 2012 Frankenstorm that started out as hurricane Sandy had a devastating effect on the eastern seaboard of the United States. In situations like that it is critically important for the sick, elderly and those who are recovering from organ/tissue transplants and other procedures to be specially prepared to provide accurate medical information to emergency responders.
Being prepared for Frankenstorms is essential but mini storms pop up every day. You never know when for no apparent reason your blood pressure increases dramatically, you have difficulty breathing, you experience unexplainable weight gain or an angina attack sends you to the emergency room. When that happens someone is going to ask what meds you are on, how often you take them, their dosage, contact information for your medical team and insurance info. Under pressure and when sick it is not uncommon to forget important information. That’s why I developed this list. If you have already done what I recommend then review and update your effort. If you haven’t, do it now while you have the time.
Developing the following information could save your life. There is nothing that can help emergency responders or medical professionals more than providing them with the information suggested below. It is critically important to your life that you take the time right now to do the following:
Information to include on an emergency medical information fact sheet: (sample at the end of this blog)
- Your full name, address and phone number
- Next of kin or person(s) who should be notified in case of your emergency including contact information (names, phone, address, email, cell phone)
- Your Primary care physician name and phone number
- Specialty care physicians names and numbers
- The pharmacies you use (include phone numbers)
- Health insurance company, agent and policy numbers (If on Medicare or Medicaid include that notation with account numbers).
- Prescription insurance numbers
- List all the medical conditions for which you are being treated
- List all surgeries
- Blood type
- Write down every medication you take whether by prescription or over the counter. Include milligrams for each, how often you take them and for which medical condition.
DO NOT GO ANYWHERE WITHOUT AT LEAST A WEEK’S SUPPLY OF YOUR MEDS! This is especially important during a disaster situation in which transportation, emergency and other services are strained, temporarily unavailable or even suspended.
Some people, transplant patients and recipients in particular must take certain medications to stay alive. In situations like storms or other natural or unnatural disasters and emergency situations you could be faced with a situation in which you are unable to go home to retrieve your medications and other important belongings. I suggest you do what I do and that is to keep a shoulder bag packed with your meds and other medical equipment that is within your reach at a moment’s notice. If possible you should also try to stash some cash in your emergency bag. You might find yourself in a situation where checks and credit cards are useless.
If you have a cell phone and an extra charger, put it in your meds bag. If you don’t have an extra charger keep the one you have in your meds bag when you are not using it. There is nothing worse than being unable to get to your charger when your phone is going dead. That phone could be your link to safety and treatment.
If you wear a medical necklace or bracelet, make sure it is up to date and accurate. If you don’t wear one and have time, get one.
When you have completed the medical emergency list (it should all fit on one sheet of copy paper) make two or three copies, fold them carefully and put them in your purse or wallet. Emergency medical people can be of the most help if they are aware of your medical history, current medications and other treatments you may be getting. Having that list in your possession and providing it to medical experts could save your life. While you may know all of this information, do not depend on your memory. One omission could prove to be catastrophic. You must also remember to update the list every time you get a new medication, quit using one, or have any change in your medical condition.
A separate list should be developed for your personal use. It should include phone numbers of emergency services you might need and iportant family and friend contacts you might need (include cell phone numbers and email addresses).
Sample Medical Info Sheet to Carry With You
HEART TRANSPLANT RECIPIENT
Best Hospital USA August 21 2007 Immunosuppressed
Birth date 2-17-1950
9180 orchard lane Anycity, USA
Home 555-555-5555 Cell phone 555-555-5555
SS # 555-55-5555
Spouse; Jane Doe; Cell phone 555-555-5555
Primary, Dr.Sawbones Anycity USA. Address, phone numbers
Transplant Pulmonologist, Dr. Breatheasy best clinic USA.
Address, phone numbers
Transplant Cardiologists, Dr. Heartthump best clinic USA.
Address, phone numbers
Transplant Coordinator: Nurse Jane best clinic USA/
Address, phone numbers
Primary: Best Pharmacy USS.
Address, phone numbers
Secondary: Second best pharmacy USA.
Address, phone numbers
Primary — Medicare part A, Hospital, part B, Medical. Policy number other info
Secondary, AARP Medicare Supplement . policy number other info
Medicare part D Prescriptions, AARP Medicare RxEnhanced policy number, other info
ALLERGIES: Penicillin, cats, all seafood/fish, mold, dust.
BLOOD TYPE: B Positive
Heart related medications
- Anti-rejection Cyclosporine 200 mg twice a day
- Anti-rejection — Cellcept 1000 mg twice a day
- Anti-cholesterol — Prevastatin 20 mg once a day
- Blood Thinner – Aspirin 81 mg once a day
- Blood Pressure – Amlodipine Besylate 5 mg twice a day
- Reflux – Omeprozole (Prilosec) two 40 mg twice a day
- Thyroid — Levothyroxine .088 MG once a day (upon arising)
- Asthma – ProAir albuterol rescue inhaler as needed
- COPD – Foradilinhale one capsule twice a day
- COPD – Spiriva inhale one capsule once a day (upon arising)
- Depression-Remeron 7.5 –mg once a day-
Calcium – 600 mg tablet with Vitamin D twice a day
Multi-vitamin– one tablet once a day
- Asthma, hay fever, allergies diagnosed 1951
- COPD diagnosed October 2000
- Restless leg syndrome diagnosed 1996
- Chronic lower back pain
- Heart transplantBest Hospital
- Anywhere USA August 2007
- Cholecystectomy 1994
- Total left knee replacement 1998
This list is on my computer and on my cell phone. Also, I carry two paper copies in my wallet at all times and update it whenever there is a condition, prescription, insurance or medical team change. Every time I hand this list to ER personnel, or anyone else who asks for it they all say the same thing, “Everyone should carry a list like this it is of invaluable help to us and could save your life.”
Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s over 3,000 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.
You may comment in the space provided or email your thoughts to me at email@example.com. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.
Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative The more members we get the greater our clout with decision makers.