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Paul Hsieh Forbes Column: UK To Experiment on Cardiac Arrest Patients Without Their Consent

 Posted by on 28 August 2014 at 10:00 am  Activism, Ethics, Health Care, Op-Eds, Science
Aug 282014
 

My latest Forbes column is now up: “UK To Experiment on Cardiac Arrest Patients Without Their Consent“.

Here is the opening:

Soon, thousands of UK cardiac arrest patients may find themselves enrolled in a major medical experiment, without their consent. This may be legal. But is it ethical?

As described by the Telegraph:

“Paramedics will give patients whose heart has stopped a dummy drug as part of an ‘ethically questionable’ study into whether adrenalin works in resuscitation or not… Patients in cardiac arrest will receive either a shot of adrenalin, which is the current practice, or a salt water placebo but the patient, their relatives nor the paramedic administering it will know which. The trial is seen to be controversial because patients will not be able to consent to taking part and could receive a totally useless placebo injection…”

First, I want to emphasize that this is a legitimate scientific question. Adrenaline (also known as epinephrine) has been a standard part of the resuscitation protocol for sudden cardiac arrest, along with chest compressions and electrical shocks. (Think of paramedics shouting “clear” on television medical dramas.) But more recent evidence suggests that adrenaline might cause more harm than good in this situation, helping start the heart but possibly also causing some neurological damage. There is a valid and important scientific question. My concern is not over the science behind the experiment, but rather the ethics…

(For more details and discussion, read the full text of “UK To Experiment on Cardiac Arrest Patients Without Their Consent“.)

There are two parts of the study that disturb me the most: (1) The drug trial itself, and (2) the decision to not actively inform relatives that any patient who died had been an involuntary participant.  I cover both aspects in more detail in the piece.

Note: I’m not fully settled on what (if any) experimentation should be allowed on incapacitated patients in an emergency setting without informed consent.  But I do think this should be an issue of active discussion, especially for the people whose lives are on the line.

And for a discussion of prior US medical experiments that have been alleged to be unethical, non-consensual, or illegal, see this Wikipedia list.

 

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Monica Hughes on the VA, FDA, and American Health Care

 Posted by on 19 August 2014 at 10:00 am  Activism, Government, Health, Health Care, Medicine, Science
Aug 192014
 

Monica Hughes recently gave an excellent talk on, “The Transformation of American Healthcare: Lessons from the Veterans Administration and Existing FDA Standards of Care” to Liberty On The Rocks at Flatirons.

 

Her talk is now available on YouTube (3 parts).

Part 1

Part 2

Part 3

Disclaimer and synopsis:

DISCLAIMER: The speaker is not a medical doctor or health care practitioner. The ideas in this video are not intended as a substitute for the advice of a trained health professional. All matters regarding your health require medical supervision. Consult your physician and/or health care professional before adopting any nutritional, exercise, or medical protocol, as well as about any condition that may require diagnosis or medical attention. In addition, statements regarding certain products and services represent the views of the speaker alone and do not constitute a recommendation or endorsement or any product or service.

Synopsis: In January 2014, Robb was diagnosed with glioblastoma multiforme (GBM), one of the deadliest brain cancers in existence. Nicknamed “The Terminator” the median survival time is around 11 months. Robb had brain surgery on January 16, which was performed by a team of surgeons while Robb was awake. The surgery was a success.

Monica’s research into the post-surgery treatments that worked best for other survivors showed that they were not approved by the Food and Drug Administration, so they’d have to go to a cancer center that sprouted up in Tijuana, Mexico for treatment which included a 100 year-old immune system booster called Coley’s Vaccine.

Bio: Monica Hughes has bachelor’s, master’s, and PhD degrees in biology and has taught college biology since 2006. Previously, Monica served as a medical writer for National Jewish Health, a premier research hospital for respiratory and immune disorders, and is now a patient advocate specializing in literature research.

Robb LeChevalier has served in the Air Force and has a bachelor’s degree in electrical engineering. He designed his own home situated in the foothills outside of Denver, and currently develops high speed electronics for his own company, Astronix Research. He has been an Objectivist for 40 years.

More: Robb was given 2 months to live without surgery, a maximum of 6 months to live with surgery only, and an unspecified amount of time with additional therapy due to the unusually aggressive nature of his particular tumor. He and his wife Monica faced seemingly insurmountable hurdles by the Veterans Administration along the way, including timely care from the VA and a delay of emergency surgery that could have cost Robb his life had they not pushed for a special dispensation from a panel of VA doctors within the 48 hours leading up to his scheduled surgery. They are currently contesting 58 claims denials by the VA totaling nearly $250,000 in unpaid medical bills.

In the days following Robb’s surgery, they discovered that immunotherapy held the best chance of long-term and quality survival for this cancer. Historical 3 year survival with FDA-approved standard of care for GBM is around 7%. 3-5 year survival for some GBM patients in clinical trials using cancer vaccines is between 20%-50%, depending on the vaccine. Yet they discovered that due to FDA regulations, it is impossible to enter these clinical trials without first or concurrently undergoing FDA-approved standard of care, and that such care would greatly reduce his likelihood of responding to immunotherapy, if he was lucky enough to meet the criteria for the study and be placed in the treatment arm of such a trial.

Given these poor odds, Robb chose to forego all standard of care therapy after surgery, and opted for an immunotherapy protocol abroad that, according to current MRI results, has left him without evidence of disease. As of June 10, 2014, their new low deductible PPO health insurance policy, purchased on the Obamacare exchange, has not paid out a single penny of reimbursement for Robb’s cancer treatment.

(Note: I also discussed their case in my 5/28/2014 Forbes piece, “VA Denies Coverage For US Air Force Veteran With Malignant Brain Tumor“.)

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Paul Hsieh Forbes Column: No, Gun Violence Is Not a ‘Public Health’ Issue

 Posted by on 29 July 2014 at 10:00 am  Activism, Health Care, Politics, Self-Defense
Jul 292014
 

My latest Forbes piece is now up: “No, Gun Violence Is Not a ‘Public Health’ Issue“.

I discuss 4 reasons we shouldn’t frame “gun violence” as a “public health” issue, including:

1) Gun violence is not an “epidemic”, except in a metaphorical sense.

2) If “public health” includes “gun violence”, then intellectual fairness demands that we consider pro-gun arguments as well as anti-gun arguments.

3) Expanding “public health” to include “gun violence” diverts us from genuine public health threats.

4) Guns are not the doctor’s “natural enemy.”

Although I think gun crime should not be shoehorned into the category “public health”, I recognize that others may disagree. In that case, lives saved by allowing concealed carry should be just as much of the “public health” discussion as lives lost to gun violence.

For more details on each of the four points above, see the full text of “No, Gun Violence Is Not a ‘Public Health’ Issue“.

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Paul Hsieh Forbes Column: Three Factors That Corrupted VA Health Care

 Posted by on 2 June 2014 at 10:00 am  Activism, Government, Health Care
Jun 022014
 

My second Forbes piece in two days again discusses the VA health scandal: “Three Factors That Corrupted VA Health Care And Threaten The Rest of American Medicine“.

Here is the opening:

Veterans Affairs Secretary Eric Shinseki has resigned in the wake of the waiting times scandal. But the problems at the VA go much deeper than a single man. His eventual successor will have his hands full dealing with the toxic combination of problems that fueled the crisis: a shortage of doctors, perverse incentives, and a widespread culture of dishonesty. And these problems could affect the rest of America under ObamaCare…

The first two of the three factors are already in play under the Affordable Care Act (aka “ObamaCare”) and there are troubling early indicators that the third may take root as well.  If this happens, Americans had better watch out.

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Paul Hsieh Forbes Column: VA Denies Coverage to USAF Veteran With Brain Tumor

 Posted by on 30 May 2014 at 10:00 am  Activism, Government, Health Care
May 302014
 

My latest Forbes piece is now up: “VA Denies Coverage For US Air Force Veteran With Malignant Brain Tumor“.

I discuss the bureaucratic hurdles that USAF veteran Robert LeChevalier had to endure when diagnosed with glioblastoma multiforme (a very malignant brain tumor).  Fortunately, he and his wife Monica Hughes have a lot of grit and tenacity.

I’m glad to publicize their open letter to the VA, and I hope it gets some attention!

Monica also posted this photo, which I used in the Forbes article with her permission:  “Here are the 58 claims denials, totaling $250,000 of emergency care, that we have received by the Veteran’s Administration. Excuse? Robb was too healthy. He hadn’t sought any care at the VA in the prior 5 months. Really.”

 

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Paul Hsieh Forbes Column: Should Doctors Limit Medical Care To Save Money For ‘Society’?

 Posted by on 22 April 2014 at 10:00 am  Activism, Economics, Health Care
Apr 222014
 

My latest Forbes piece is now up: “Should Doctors Limit Medical Care To Save Money For ‘Society’?”

Here is the opening:

Can your doctor serve two masters at once?

That’s the question American physicians are grappling with. The New York Times recently reported on a growing debate within the medical profession as to whether doctors should make treatment decisions in the best interests of their individual patients — or if they should limit care to save money for “society.”

This would represent a seismic shift in standard medical ethics. Traditionally, a doctor’s primary ethical duty is to the patient. Patients literally put their lives in our hands, trusting that their physician will always act as their advocate. But with health care costs currently consuming 18% of the US economy (and an enlarging share of government budgets), some doctors are openly calling for fellow physicians to limit their use of more expensive tests and therapies to save money for “the larger society.”

As Dr. Martin Samuels (chairman of neurology at Brigham and Women’s Hospital in Boston) warned in the Times piece, doctors risk losing patients’ trust if they say, “I’m not going to do what I think is best for you because I think it’s bad for the health care budget in Massachusetts.”

We don’t expect our lawyer to balance our legal interests against saving money for “the court system” or our real estate agent to balance our housing preferences against what’s best for “the regional housing market.” Shouldn’t our doctors adhere to the same code of ethics?…

I also discuss how this conflict of interest will worsen under ObamaCare as well as how adapting an idea by UCLA law professor Russell Korobkin may help avoid this problem and protect the doctor-patient relationship.

For more details, read the full text of “Should Doctors Limit Medical Care To Save Money For ‘Society’?“

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Paul Hsieh Forbes Column: What The US Can Learn From the Australian Health Care Debate

 Posted by on 1 April 2014 at 10:00 am  Activism, Health Care, Politics
Apr 012014
 

My latest column is now available at Forbes: “What The US Can Learn From the Australian Health Care Debate“.

Here is the opening:

Is it fair to ask a patient to pay $6 for emergency medical care? Or are patients entitled to free medical care whenever they need it? That’s the question Australian government officials are currently grappling with.

As the Australian health care unfolds, there are two lessons for Americans — one political and one philosophical.

For more details, read the full text of “What The US Can Learn From the Australian Health Care Debate“.

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Paul Hsieh Forbes Column: Can You Trust What’s In Your Electronic Medical Record?

 Posted by on 25 February 2014 at 10:00 am  Activism, Health Care, Politics, Technology
Feb 252014
 

Forbes has published my latest column: “Can You Trust What’s In Your Electronic Medical Record?”

I discuss how government-mandated electronic medical records are hampering doctors’ ability to practice and resulting in medical errors. I also discuss 4 concrete steps patients can take to protect themselves.

I didn’t mention this in the Forbes piece, but there was a terrific drawing in the Journal of the American Medical Association from a couple of years ago by a 7-year old girl depicting her recent doctor visit. Even young children understand the effect of electronic medical records on their care:

No one was more surprised than the physician himself. The drawing was unmistakable. It showed the artist — a 7-year-old girl — on the examining table. Her older sister was seated nearby in a chair, as was her mother, cradling her baby sister. The doctor sat staring at the computer, his back to the patient — and everyone else. All were smiling. The picture was carefully drawn with beautiful colors and details, and you couldn’t miss the message…

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Paul Hsieh Forbes Column: How ObamaCare Creates Ethical Conflicts For Physicians

 Posted by on 29 January 2014 at 8:00 am  Activism, Economics, Health Care, Politics
Jan 292014
 

Forbes has published my latest column, “How ObamaCare Creates Ethical Conflicts For Physicians And How Patients Can Protect Themselves“.

Here is the opening:

Do you trust your doctor? Most patients assume their doctor is working in their best medical interests whenever he or she orders a diagnostic test or recommends a particular treatment. Customers might wonder whether an unscrupulous auto mechanic is being truthful when he recommends a brake job or a new transmission. But most patients trust that their doctor isn’t recommending unnecessary surgeries merely to line his pockets.

The vast majority of doctors take their ethical responsibilities very seriously. Prior to ObamaCare, only a relatively few “bad apples” have chosen to compromise their professional ethics for financial gain. However, ObamaCare creates new ethical conflicts for doctors. We’ll examine some common physician conflicts of interest before and after ObamaCare, and discuss how patients can best protect themselves…

Prior to ObamaCare, physicians faced perverse incentives for overtreatment. Physicians might also be tempted to pad their income through inappropriate self-referral or business relationships such as “physician owned distributorships”.

After ObamaCare, physicians will face perverse incentives for undertreatment, especially with “bundled payments” and government “appropriate use criteria”.  The new “narrow networks” required by many ObamaCare exchange plans will exacerbate these issues:

To cut costs, many ObamaCare exchange plans also require “narrow networks” of providers, where patients may only receive treatment from a short list of approved hospitals and doctors. President Obama has repeatedly promised, “If you like your doctor, you can keep your doctor,” but many patients are learning the hard way that this isn’t true.

Such “narrow networks” also mean that many doctors will lose long-standing relationships with patients they’ve seen for years. Instead, doctors will be increasingly reliant on the government-run exchanges for new patients. This will create a powerful incentive for physicians to adhere to any treatment guidelines mandated by the government or by government-approved insurance plans.

I also discuss several ways patients can protect themselves from these old and new physician conflicts of interest.

For more details, see the full text of “How ObamaCare Creates Ethical Conflicts For Physicians And How Patients Can Protect Themselves“.

[Crossposted from the FIRM blog.]

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Paul Hsieh Forbes Column: Obamacare Spends ‘Other People’s Money’ To Make Healthcare Expensive And Scarce

 Posted by on 24 December 2013 at 10:00 am  Activism, Health Care, Politics
Dec 242013
 

Forbes has just published my latest column: “Obamacare Spends ‘Other People’s Money’ To Make Healthcare Expensive And Scarce“.

I discuss 4 dangers of a health system based on spending ‘Other People’s Money’.  In other words, it’s not just that the money will run out some day!

Those dangers include:

1) Doctors will be increasingly expected to save money “for the system”

2) This will further fuel the nanny state

3) Health benefits will become increasingly politicized

4) Sooner or later, government spending Other People’s Money means the government taking your money

I also discuss how to avoid these problems.

(And many thanks to Ray Niles for finding that great Walter Williams quote.)

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