Thursday, May 21, 2009

How the world really works

Is it a good idea to have medical records stored in electronic form rather than paper? Maybe. One argument is that if there are stored electronically, it will help us find the "best" treatments because we will have all kinds of data. This optimism may be warranted. Against it, is the consideration that "best" is often unclear, depends on the individual, depends on the cost, and is subject to political manipulation if the determination of the "best" treatment is a government decision.

Another argument often advanced for electronic records is cost-saving. It will prevent needless duplication. But of course mobilizing the medical profession to do something they don't seem to think worthwhile doing on their own will have its own costs as well.

This article in the Washington Post deserves to be read in its entirety. It explores how implementing electronic records became part of the stimulus bill. Not because it's a great idea but because the people who would profit from it lobbied like crazy. It may be a great idea. Suffice it to say that the evidence is highly biased. At the center of this picture is the proposed savings in costs of $77 billion. But as the Post reports:
The stimulus bill suggests that the government will recoup about a third of the spending allocated for electronic health records over the next decade, an assumption that some health-care observers question, in part because of a critical analysis by the Congressional Budget Office last year.

The CBO, then led by Orszag, examined the industry-funded study behind the $77.8 billion assertion, among other things, and concluded that it relied on "overly optimistic" assumptions and said much is unknown about the potential impact of health information technology.

A CBO analysis of the stimulus bill this year projected that spending on electronic health records could yield perhaps $17 billion in savings over a decade.

This is how the world really works. When Obama says that electronic record-keeping is a crucial way to control costs, it seems like a really cool idea. It may be. But I doubt it. And the real reason we're going this route isn't because a wise President sees a cost-saving opportunity. It's a lot uglier than that.

As for this being part of the stimulus plan, what a joke. The main thing that will be stimulated are the bank accounts of the people who make the products that help computerize the records.


Why is the NHS killing so many with drugs?

An extraordinary rise in the number of patients killed by drugs given out by the Health Service has led to calls for an investigation. The figure has more than doubled since Labour came to power, rising from 520 in 1998 to 1,299 last year. Official figures also show that the number of such deaths last year was up by more than a quarter on the figure of 1,030 recorded in 2007.

Liberal Democrat health spokesman Norman Lamb, who obtained the statistics following a parliamentary question, said: 'The Government needs to urgently investigate this extraordinary rise. 'The public needs to know why these adverse reactions are happening more frequently and why the trend appears to be increasing so much. 'Patient safety is being compromised. Ministers must ensure that better information on prescription drugs is available for patients and doctors.'

Some experts blamed the increase on failures in the training of hospital doctors and Labour's decision to hand greater prescribing powers to nurses.

The figures show that in 2008, a total of 25,424 reports of adverse reactions to drugs - both fatal and non-fatal - were made to the Medicines and Healthcare products Regulatory Agency, the government organisation in charge of drug safety. They were up by 17 per cent on 2007 and by 41 per cent in a decade. Of these patients, 4,487 had to stay in hospital for several days following side effects from medication - around the same as in 2007 but up by more than 50 per cent on 1998. The figures mainly cover drugs handed out on prescription, but they also relate to over-the-counter and herbal medicines.

Peter Walsh, of pressure group Action Against Medical Accidents, said: 'There are far too many complications resulting in harm or death. These numbers must be reduced, and it must be in the gift of a modern NHS to get them down. 'The true figure will undoubtedly be much higher, because not all incidents are reported [by hospitals and GPs]. And in many cases doctors simply do not know what caused a sudden deterioration or a death - the drugs or another cause. 'Problems with medicines are one of the biggest patient safety issues faced by the NHS.'

Mr Walsh said better reporting of adverse reactions could be the reason behind some of the rise. But there was also the problem of new drugs, and complicated therapies that include combinations of drugs. These 'cutting-edge' treatments often have unknown side effects. Adverse reactions can also occur where doctors do not know what other drugs a patient is taking, or about allergic reactions they suffer from. Errors in identifying patients - with drugs being given to the wrong patient - and in dosages, also cause numerous deaths, he said.

The Daily Mail revealed in January that the number of patients killed by hospital blunders has soared by 60 per cent in only two years. Official records show that 3,645 died as a result of outbreaks of infections, botched operations and other mistakes in 2007/2008, up from 2,275 two years before.

Critics say that the quality of NHS care has suffered as doctors and nurses come under pressure to meet Government waiting time targets. A spokesman for the MHRA said a number of factors are thought to have played a role in the rise in fatal adverse drug reactions including changes in pharmaceutical companies' reporting of the reactions and increased prescribing of drugs. 'It is not possible to pick out one single factor influencing this trend,' she added.


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