Posts made in December, 2014


Computed tomography (CT) scans can help doctors to avoid missing or delaying a diagnosis of cancer or other serious medical conditions. However, the exposure to ionizing radiation that these tests involve may, at the same time, increase a patient’s risk of developing cancer.

This why many doctors and organizations are calling for patients to learn more and discuss the risks and benefits of a CT scan with their doctor before they undergo one, as ABC News/Health.com recently reported.

According to the article, CT scans have become increasingly used by doctors to check a patient for cancer due to the fact that they are cheaper and faster than MRIs or exploratory surgery and provide more detail than traditional X-rays. Between 1980 and 2013, the number of CT scans performed each year in the U.S. soared from around 3 million to 76 million, the article states.

However, a patient undergoing a CT scan generally receives a high dose of ionizing radiation. While the body can repair damage caused by small doses of radiation, the high dosage in a CT scan is one that simply overwhelms the body’s “repair mechanisms,” potentially leading to cancer, the article states.

The cancer risk is higher if a patient undergoes multiple CT scans, and women may face a higher possibility of developing cancer from the radiation than men, according to ABC News/Health.com.

The report cites a 2009 National Cancer Institute study which found that 29,000 future cases of cancer could result from 72 million CT scans that were performed in the U.S. in 2007.

Cardiologists Call for Patient-Doctor Discussion About CT Scans

As Reuters reports, several medical organizations issued a statement in September2014 in the medical journal, Circulation, which urged doctors to carefully discuss the risks and benefits of chest CT scans with their patients and to explain to patients why a CT scan was being used in their case.

Ultimately, a patient and doctor must “share” the decision to go forward with the test, according to the statement, which was signed by organizations that included the American Heart Association and American College of Cardiology.

Dr. Andrew J Einstein of Columbia University in New York told Reuters that patients should not necessarily be “scared off” by the discussion or refuse undergoing what could be a potentially life-saving test.

Still, Einstein said, “As doctors, it is our obligation to make sure that we, our colleagues and our patients understand the potential benefits of a medical imaging study as well as potential risks,” according to Reuters.

Questions You Should Ask Your Doctor

If you are suffering symptoms of cancer or any other serious medical condition, your doctor may tell you that he or she would like to order a CT scan. Before you agree to undergo the test, ask your doctor:

  • What specific symptoms make the CT scan necessary?
  • Could alternatives such as X-rays, MRIs or ultrasounds be used instead, and how do those alternatives compare to a CT scan in terms of risks and benefits? You may also ask about how the alternatives compare in terms of cost and the amount of time involved to perform each one.
  • If a CT scan is needed, what is the typical dosage of radiation for such a scan and/or the actual dosage that will be used in this specific test?
  • Will there be additional CT scans? If so, how many more tests? What are the risks and benefits of multiple CT scans?

The bottom line is that you have the right, as a patient, to have as much information as possible about the tests your doctor orders you to undergo. Ultimately, if you find that the risks outweigh the benefits, you have a right to withhold consent and seek a second medical opinion.

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Confidentiality between doctor and patient has always been a given in the United States, and it’s something we have long taken for granted. However, that confidentiality isn’t as airtight as many may think. On the contrary, pharmacies such as CVS and Express Scripts have been selling anonymous prescription information to data mining companies for years. Why? It’s an effort to target advertisements to patient’s prescriptions and health conditions. The process is called matchback, and it has rightfully raised concerns about federal medical privacy laws.

How ‘Anonymous’ is It?

Matchback is allowed because the names of the patients are said to be concealed, though to many, that doesn’t justify the breach of confidentiality. IMS Health Holdings and other data brokers have collected prescription records numbering in the hundreds of millions, and they say the names of the patients are replaced by unique codes that are generated using algorithms. But, opponents of the practice are concerned that such technological advances undermine privacy laws, specifically the Health Insurance Portability and Accountability Act (HIPAA).

Confidentiality and Transparent Disclosure Concerns

While advocates of the matchback process claim that patient’s names are not directly connected to the prescription information, not all pharmaceutical companies are comfortable with it. For example, industry giant, GlaxoSmithKlinePlc, stopped engaging in the practice after its leadership became concerned about the potential for violating consumer privacy, and because not all websites were notifying users. The company’s legitimate concerns about transparent disclosure for internet users and breeches of confidentiality are at odds with other pharmaceutical companies, like Sanofi, that do use matchback to target consumers.

Money to be Made

Pharmaceutical companies aren’t the only ones who must choose whether or not to engage in prescription drug data mining. Internet companies can profit from it, too, so they have a decision to make as well. Yahoo has decided in favor of matchback. The company has been using IMS Health Holdings, Inc., one of the biggest data brokers, to target ads through matchback since 2011. Even though Yahoo’s privacy policy does address information sharing and disclosure, it does not specifically mention the release of information relative to prescription drugs. Yet, the internet giant, along with IMS, reportedly holds the records of some 100 million people. What’s the draw? Money, of course. Matchbacks can add $100,000 to the price tag of a digital advertising campaign.

Not all internet giants are on board with the selling of ‘anonymous’ prescription records though. Like SmithGlaxoKlinePlc, Facebook, Google and Microsoft don’t use matchbacks in their ad targeting strategies either. Perhaps the money to be made just isn’t worth the risk to them, especially given the breaches of information that occur. Opponents of matchback point to such breeches as evidence that long term tracking poses a risk to patient privacy regardless of how the data is presented, or who is in control of it.

Whether or not the mining of prescription data is legal, many believe that it is unethical. Opponents of the process argue that all health records should be kept confidential. Regardless of whether there is a name or random number attached to it, they claim, medical information is too personal to expose to any level of risk.

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Medical professionals usually strive to provide the very best medical care to patients. They want to administer the right tests, prescribe the right medications, and perform needed surgeries flawlessly.

But humans make mistakes despite best intentions, including doctors and nurses. Sometimes those mistakes are the result of carelessness and actions that fall short of the accepted standards of medical care.

Patients injured as a result of medical mistakes have the right under the law to seek monetary compensation for their injuries, including medical bills, lost wages, and pain and suffering. This legal right undoubtedly helps to keep medical professionals accountable for their actions and provide a semblance of justice to injured patients and their loved ones.

But some states have passed laws that restrict the right of injured patients to seek compensation for medical malpractice. Despite dubious data, these laws are cast as a protection against “frivolous” lawsuits and a reduction of medical costs.

In the real world, these laws can put injured patients and their loved ones into legal limbo with little hope of recovering compensation for injuries, and – even more important – getting real answers to just went wrong.

A tragic Wisconsin story is a case in point.

A 91-year-old man died after breaking his pelvis when he fell off a table in a hospital while being prepped for a routine heart procedure, according to a recent article in the Milwaukee Journal Sentinel. Prior to falling, the gentleman was largely independent and able to get around on his own. He was the primary caretaker of his ailing 88-year-old wife of 65 years, attending to her needs in their home and transporting her around town.

Wisconsin has thrown up legal roadblocks for those seeking compensation for medical malpractice, and, perhaps just as troubling, obtaining information about details on medical incidents.

Similar to numerous other states, Wisconsin has placed a cap on the amount of pain and suffering damages an injured patient can receive in a lawsuit. The cap amounts vary from state to state, and in Wisconsin the limit is $750,000.

Another restriction facing the widow and her adult children: Under a unique Wisconsin law, only a surviving spouse and minor children can pursue a wrongful death lawsuit. Should the ailing widow pass away before the conclusion of a lawsuit, the wrongful death claim would end immediately. This increases the risk for an attorney to represent the woman, especially considering the relatively high expenses typically associated with pursuing a medical malpractice case.

In fact, this law creates an incentive for the hospital and its insurer to delay payment on the claim as well as resolution of any legal case.

Yet another law in Wisconsin impinges on the ability of the family of the deceased man to get answers to what went wrong. They still don’t know exactly how he fell off the prep table in the presence of medical personnel at the hospital, according to the Milwaukee Journal Sentinel.

The law bars patient access to confidential “incident reports” written by staff in hospitals, nursing homes and other health care providers, and from using the reports in civil or criminal cases. The law purportedly encourages medical professionals to be more forthcoming about the details of treatments and medical services provided to patients when accidents occur, with the ultimate goal of improving health care procedures.

But sunshine is the best disinfectant, right? Transparency and accountability to patients would more likely lead to improvements in medical care, rather than circling the proverbial wagons, and keeping incident reports under lock and key.

Achieving consistently outstanding health care is inarguably a goal shared by everyone. However, laws such as those in Wisconsin that limit the legal rights of injured patients do not appear to further that goal, and instead appear to favor the health care industry and insurance companies.

This article provided on behalf of Scott Gottlieb at Scott C. Gottlieb & Associates, LLP.

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