Author: Laura Newman

He Changed His Mind: Reflections
On Decline and the End of Life

Laura Newman 2 Comments
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Guest Post By Richard Krawiec

Three weeks ago Monday I got a call saying my sister had found my 92-year-old father, who had been living on his own, on the bathroom floor, where he’d lain for 12 hours after suffering a massive stroke. I was told he was paralyzed on the left half of his body, always would be, would probably never regain mental functioning or language, and if he did survive it would be in such a severely reduced state it would be like no life at all. He already had prostate cancer and it seemingly had metastasized to his skull and ribs. He developed pneumonia, and an infection. He had a DNR in place, and it appeared the medical people were in agreeance there was no hope.

But he could breathe on his own.

I was out of town at a residency and had to figure out how to get money for flights, try to coordinate with my two sons, was in frequent contact with my brother to find out if death were imminent or might take days or weeks or months. No one seemed to know, although there seemed to be a consensus he was quickly headed for hospice.

i went up to MA.

He was still breathing on his own. He was communicating in brief phrases. He recognized people. He began to move his left foot in small gestures in response to commands.

He said he didn’t want to quit. Although he had a DNR in place, which said he didn’t want to have a feeding tube, or go to a nursing home, he changed his mind, said he wanted to “work hard” at rehab.

Today, he pedaled a bit on an exercise bicycle – 94% of the time without assistance – from his wheelchair. He did five assisted leg stands on the parallel bars. He wanted to be put on the patio in the sun, instead of his room to nap.

Sometimes it takes a while for people to make their feelings known. Sometimes people change their minds about papers they signed when in full health. Sometimes we just need to be patient and wait for clarity and listen.

Richard Krawiec is a writer and the founder of Jacar Press. He lives in Durham, North Carolina.

Commercial Physician Review Sites Tend to Miss the Mark

Laura Newman 3 Comments
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Are you hoping that you’ll find a new doctor by looking at online physician review sites? About 60% of people look there, but a new study suggests these sites offer little. Many physicians are not rated at all. For those that are, their reviews are in the single digits, the study reveals. Some are limited to overall star reviews and narratives about the patient experience are sparse.

“These review sites have not evolved,” said Tara Lagu, MD, MPH, who led the study published in today’s Journal of the American Medical Association. Lagu has been studying this field since 2009.“Patients want to find someone who shares their values or because they have a specific condition that they want a physician to manage.” However, the sites were difficult to navigate and information on conditions treated, physician gender, hospital affiliation, languages spoke was lacking in general. The analysis focused on three metropolitan areas (Boston, Portland, Oregon, and Dallas), according to Dr. Lagu, research scientist and hospitalist at Baystate Medical Center and University of Massachusetts Medical School Baystate, Springfield, Massachusetts. These are diverse areas, but exactly how representative they are of other areas remains unclear.

Only Ten Sites Satisfy Bare Minimum Number of Reviews 

The research team evaluated 66 potential physician web sites, but the published analysis is limited to sites that published reviews for at least five physicians. This left them with reviews for Vitals, Healthgrades, Vitals, UCompareHealthCare, RateMDs, Lifescript, DrScore, Wellness, Yelp, and GooglePlus. One third of doctors sampled in a given area had no reviews.

The public may do better at uncovering issues with credentialing issues, quality measures, and physician conflicts of industry by turning to publicly available state licensing boards (for example, for New York State), quality reports, and sites like ProPublica, which show surgeon complication rates and payments to docs from industry, in their Dollars for Docs page. However, these were not the subject of this study.

Looking ahead, it’s unclear whether information that becomes available will prove helpful in selecting a primary care doctor. The Centers for Medicaid and Medicare (CMS) has been hoping to build on surveys like the Consumer Assessment of Healthcare Providers and Systems (CAPHS), which have been around for decades. You may have received surveys within the past few years from hospitals or practices required to send out patient experience surveys. Do you complete them? Do you think that they help people and providers provide better care?

If we assume MD rating sites will proliferate, what kind of information would you like to see on them? Do you find these sites limited?

 

 

 

 

Healthcare Price Transparency: A Look at Aetna’s Web-Based Tool

Laura Newman
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Illustration source: Vermont Health Connect, Vermont.gov

Would you look at comparative price information for procedures like an MRI, sleep study, or colonoscopy before you selected where to have a procedure done? Would you like to have fewer surprises on what you will pay before you go in for these procedures? Price transparency in health care has been a rallying cry, from many policymakers, elected officials, and journalists. It’s one strategy among many that many back as a way to get health care spending down and also offer consumers choice.

Many view healthcare as a market that can bring costs down when competition and comparison-shopping are in play. Others want transparent prices so consumers face no surprises before getting an astronomical bill. In both examples, the onus is on the public to choose wisely and economically.

In today’s post, I review a study of Aetna’s price transparency tool for outpatient procedures, including radiology, sleep, and cataract surgery reported in the Oct. 24 JAMA Internal Medicine led by Anna D. Sinaiko, PhD, MPP, from the Department of Health Policy and Management at Harvard University’s T.H. Chan School of Public Health. This study was slated to appear here earlier, but the election madness delayed it.

Aetna’s Member Payment Estimator for Eight Elective Procedures

Aetna developed a web-based Member Payment Estimator with the idea that patients would select care based on cost to them. It shared the tool with 94% of Aetna enrollees across the United States, but in this study, it reports just a 3.5% pick-up in using the tool. 

In the study, researchers used administrative enrollment and medical claims data to review whether enrollees aged 19 to 64 who underwent one of eight different procedures reviewed price comparison data provided by episode. The eight procedures in the study were carpal tunnel release, cataract removal, colonoscopy, echocardiogram, mammogram, several MRI and computed tomography procedures, sleep studies, and upper endoscopy procedures during the period 2010 to 2012.

“The way the web-based tool works is it adjudicates claims as if you are having the procedure in real time, factoring in your specific health insurance information (e.g. deductible, copays, age and gender), so that you can see your out-of-pocket costs at ten facilities in your geographic area of residence,” said Dr. Sinaiko, in an interview with PatientPOV. “This reflects the patient’s price information in advance of receiving care.” Results were only examined within geographic areas, not across those areas.”

How Aetna’s Member Payment Estimator Was Used

Besides finding that use was just 3.5% overall, these findings are interesting:

  • Of those who did review prices prior to selecting where to get their procedure, this group did choose facilities with lower relative price estimates, in the 46th percentile in the market versus the 54th percentile in comparison groups.
  • Of the eight procedures, MRIs, CT scans, and sleep studies were the only procedures where searching price information was associated with lower spending of $131.40 (12%) (P<.001) for imaging and $103.50 (6%) (P=0.06) for sleep studies.
  • In a related paper that Dr. Sinaiko published in Health Affairs, she reported that younger patients and those with high deductibles were the most likely users of the search tool.

Dr. Sinaiko acknowledged that sharing cost information with the public is new and that “efforts to engage patients are a work in progress.” What she recommends is “more targeted outreach at the time when the decision on where to go for care is most salient.” Web-based tools like Aetna’s are likely only to be of interest for certain elective procedures and not for emergent or urgent medical problems, she added.

The Value of Transparency

Health authorities of varying political stripes are pressing for more transparency tools. It’s clear that Stephen Brill, who wrote a high-profile article in Time questioning healthcare prices, led to a public outcry for transparency. Then, others clearly view healthcare as a market that works like buying a car. So, give people the tools to choose, and perhaps they will vote for value and lower cost.

Charles Ornstein, ProPublica says: “ProPublica has been building its data tools to allow consumers and patients to compare doctors on how they practice medicine, prescribe drugs, and interact with the medical device and pharmaceutical industry.”

Yet numerous studies point to significant resistance to going for cheaper care, particularly among the well insured. Many Americans see higher costs as a proxy for better quality. While Aetna identified facilities in their high-quality network in their tool, the information shared is extremely limited and the public might be skeptical of insurer-generated quality information.

The American public will want ways to assess quality, but quality measures are in their infancy and poorly understood by most Americans. Also, costs of care may only matter for a limited number of procedures. As this study revealed, a miniscule number of Aetna enrollees considered where to get cataract surgery based on their out-of-pocket costs.

But with the recent news that healthcare premiums will rise on average about 25% in 2017, the public might have more incentive to review prices and they are bound to be pushed to look at dollars of their care or pay more.Price transparency strategies are but one approach being promoted to control costs of care. Another approach is value-based insurance design, that aims to align patients’ out of pocket costs with the value of services (evidence of benefit, etc.). PatientPOV.org will take these up in subsequent posts.

 

 

 

 

 

 

Answer Paul Ryan’s Quick Phone Survey on Whether You Back ACA/Obamacare

Laura Newman
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You have a chance to weigh in on whether or not you back Obamacare today. Paul Ryan has a phone survey for you.

It takes a short time, with a support/no support answer. These calls are logged in so they are far more important than petitions.

The number is 202-225-0600.

No conversation, but you could be on hold for 90 seconds! Do it. Share with friends, family, and coworkers!

Seven Days in November:
Healthcare and the Road Ahead

Laura Newman
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As if an acrimonious campaign and stunning election were not enough, the past seven days have been rife with anxiety and fear that the Republic is crumbling. In healthcare, the Affordable Care Act (ACA), Medicare, Medicaid–and you name it–many federal entitlements– are at risk of evisceration, with nothing substantive to replace it intended or on the drawing board. How will people get and afford healthcare under this order with no safety net?

Today, PatientPOV returns to its roots and gets back to the work of uncovering the gaps between the powers that be and the people. Any of us could be patients and caregivers at some point in our lives. Some of us have had terrible illnesses, been taken up with caregiving, and as a result, experienced economic hardships and disruption in work.

In the past few days, I began to talk with people in red states who are worried about the future of healthcare as the new order frames it. It’s premature to put it into a story, but I will write about it soon.

During the campaign, Trump didn’t have much of a health plan unless you want to call promoting health savings accounts a platform. But health savings accounts are largely limited to people with disposable incomes who can shelter money for health expenses. It’s not insurance at all. Clearly, health savings accounts were the bare minimum that alone, would not fly, post-election.

In the last seven days, Trump and Republican leaders sure have amplified their intentions. Now we are hearing about the dismantling of popular programs that have insured millions or provided a a safety net for many others. It’s overwhelming to consider the programs Trump and Republican leaders are earmarking for extinction. But I hope to air here people’s discontent about the proposed overhaul of healthcare as we know it.

If you’ve got something to say about this, please put it in the comments below. To quote Yogi: “It’s not over till it’s over.” It’s been seven days. Stand up now. Get ready for the long haul. It’s the only way forward.

 

PatientPOV to Look at Dollars
And Value in Healthcare

Laura Newman 2 Comments
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Today, I am announcing that PatientPOV will make a concerted effort to take up economic issues and value in healthcare because changes are afoot.

Everyone from health policy wonks, elected officials, and health insurers are pressing for getting value for services rendered (e.g. labs, procedures, surgery), rather than simply chalking up a lot of procedures and high-cost procedures with inattention to whether they help patients. As the environment which people find themselves shifts towards a push for getting more value per buck, as well as shifting more costs to the public, I wonder whether it is foolhardy to continue dodging complex discussions about this.

We all stand a better chance of pressing for equitable high-quality care if we are informed about the backdrop that we face, understanding its strengths and limitations. Only then can we have leverage for healthcare on fair terms.

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As part of this shift, later this week, I will cover a new study of a web-based tool introduced by an insurer that aims to give enrollees transparent price information, including their own out-of-pocket costs prior to getting specific procedures. Even though there are hurdles to sharing such information, these tools are proliferating.

Moving the Goal Posts to Catch the Ball and Other Hazards of A Chronic Fatigue Syndrome Treatment Trial

Laura Newman 1 Comment
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When it comes to offering patients high-quality care for a poorly understood disease, solid, well-funded research, medical education, and respect go a long way. In a masterful report today in STAT, Julie Rehmeyer sets the record straight on chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME). She specifically covers the many pitfalls in the landmark UK PACE trial. Rehmeyer is far from the only critic of this research.

The trial serves as a model for how not to conduct a clinical trial and criticism of it has been abundant, as Rehmeyer explains. Worse still, its conclusions that exercise and cognitive behavior therapy are effective have underpinned clinical practice guidelines around the world. That’s a bad thing because the conduct of the trial was questionable, making its recommendations moot and harmful to patients. Read her story. It’s a longread, but well worth the effort.

But I’d like you to take away from this post key problems with the PACE trial. People with ME and their caregivers need all the help and understanding that they can get. Also, many people won’t read Rehmeyer’s piece. Therefore, the more outlets that understand the neglect and misunderstanding about it, the better. Also, this blog is quite interested in the patient point of view on how to be cared for, a topic that remains undercovered and unappreciated. Note well: Rehmeyer and other ME patients add a lot to the discussion and many research scientists agree with her concerns.

 Patient Experience Departs from the Trial

Julie Portrait

As Rehmeyer explains, when she first got wind of the trial, its sheer breadth made it seem potentially valuable. “It seemed like a great study – big controlled, peer-reviewed…,” she wrote. But she delved deeper because the findings did not jibe with her experience and others living with CFS/ME.  She continues: “The hallmark of ME/CFS is that even mild exertion can increase all the other symptoms of the disease, including not just profound fatigue, but also cognitive deficits, difficulties with blood pressure regulation, unrestorative sleep, and neurological and immune dysfunction, among others.”

The trial concluded that graded exercise works – the exact opposite of how patients with CFS/ME describe their endurance. “Staying within my ever changing limits” seemed the safest course for Rehmeyer and others to stop them from spinning down into phenomenal debilitating illness.

The other cornerstone conclusion,  that cognitive behavioral therapy, or training oneself to think positive, become more active, and ignore their symptoms, felt enormously insulting to Rehmeyer and other patients, especially when other science pointed to other clues to what underpins the disease.

What’s become abundantly clear is that besides patients like Rehmeyer, immunologists have identified important patterns in the immune system and physiologists have found “highly unusual physiological changes in ME/CFS patients after exercise,” Rehmeyer points out.

There’s certainly been a long history in medicine of viewing some patients as malingerers, i.e. that they don’t want to get well. Although I haven’t seen Rehmeyer and others discuss this quite this way, I wonder whether the investigators were predisposed to viewing the patients as malingerers. I’ll be honest: I am all for making the best of a situation and trying to look on the bright side, but I am closer to Barbara Ehrenreich here, who wrote the recent book Brightsided: How Positive Thinking is Undermining America. I’ll leave it to others to explore whether the PACE investigators were unfairly biased from the get-go to think cognitive behavioral therapy must work. I am sure that many similar and some different incentives motivate health researchers pinning their hopes on it, but that’s just a hunch.

But when trials like PACE become the quintessential trial for teaching clinical practice guidelines, explanations grounded in science are tossed to the wind or not pursued.

Wouldn’t it be wonderful if research funds were allocated into the pathophysiology of ME/CFS and effective treatments were developed? Slowly, this is starting, and with more attention to the disease, more is bound to come.

PACE Hazards

What’s worse is the highly unorthodox way the trial was conducted. Above, I mentioned moving the goal posts to catch the ball. In midstream, investigators lowered the bar for self-reported recovery. Rehmeyer writes:

“Their revised definition of “recovery” was so loose that patients could get worse over the course of the trial on both fatigue and physical function and still be considered “recovered.” The threshold for physical function was so low that an average 80-year-old would exceed it.”

Rehmeyer also raises questions about the interaction between the researchers and the patients. Specifically, the way patients were asked about their self-reported symptoms also seemed questionable in leading to unfounded conclusions of marked improvement.

It Takes A Movement

To bring you up to date, PACE has been a moving target. Since the trial findings were published in 2011,  patients, scientists, and critics have fought over the merits of the trial in newspapers, peer-reviewed journals, and blogs. The times they are a changing, albeit slowly.

A Freedom of Information Request for the trial investigators to release all the data to patients succeeded in the UK. Alem Matthees, a patient from Perth, Australia, who obtained the data and led the analysis, said that the differences between groups were within the range of chance variation, and indicated no benefit of the therapies.

Together with patients, statistics professors Bruce Levin of Columbia University and Philip Stark of the University of California Berkeley have recalculated “recovery” statistics. In contrast to the study authors’ claims of recovery rates of 22%,

 the new analyses found that only 4% of patients who received exercise therapy, and 7% who received cognitive behavioral therapy (CBT) recovered, while 3% of a no-therapy comparison group did so.

An evidence review sponsored by the US Agency for Healthcare Research and Quality and finished this year, also reveals that PACE and other research into ME is wanting.  “More definitive studies are needed to fill the many research gaps in diagnosing and treating ME/CFS,” write the authors of the systematic review. On key criteria, the evidence to back widespread adoption of recommendations from previous research remains weak.

ME/CFS  is just the kind of topic that the US Patient Centered Outcomes Research Institute (PCORI)might support, if patients mounted a successful campaign for it as a priority topic.

A movement has grown and patients have every right to be indignant. All along the way, proponents of the trial have raised questions about tactics and anger coming from irate patients. But patients have been largely helpless and disrespected until now, and quibbling about their tactics sounds like a side show.

On September 27, rallies are being organized in 25 cities around the world to press for research funding for ME/CFS. The battle to garner attention to this poorly understood illness is moving forward.

 

 

 

 

Appendicitis in America: Time for Practice Change?

Laura Newman 5 Comments
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Chances are good that most readers have had personal experience with appendicitis. Appendectomy is the top inpatient surgery for kids and it far outpaces all other pediatric surgeries. Also, appendicitis is the most frequent reason adults make it to the emergency room. When people worry about their healthcare, appendicitis may seem like small change, mundane compared to big worries like chronic or debilitating conditions, and easily fixable by having your appendix surgically removed. Then it’s over.

However, the sheer volume of the surgery, done routinely and automatically in most of America, against new data that point to equivalent efficacy and a lower complication rate with antibiotic medical management for uncomplicated appendicitis make it an interesting case study of how medical paradigms change.

The tide has shifted in Europe towards using antibiotics as first-line, but probably because national health insurance programs use science much more to guide matters of the public health. In the United States, paradigm shifts towards less use of surgery come slowly and with a great deal of resistance from those threatened by the shift.

An Emblematic Case in Point

I became keenly aware of how uninformed most patients are when a friend over 70 years-old called me from the emergency room on a spring Saturday afternoon, telling me a surgeon wanted to operate on him in an hour for uncomplicated appendicitis. My initial reaction was to tell him to wait a minute because I remembered recent journal articles, notably a Finnish randomized trial suggesting antibiotic therapy had a good shot of curing the appendicitis, without the risks of surgery and an extended recovery. Appendicitis can recur in a minority of patients after antibiotic therapy, but carefully managed, one year out, there is usually no recurrence.

My friend, a skeptical medical writer to boot, had indicated that he wanted more information before he was shooed into surgery. I will say nothing more about his story because he has promised a blog post and will let him tell his story. Suffice it to say that he went the antibiotic therapy route and I am pretty darn sure that it would not have entered the picture if we hadn’t suggested it.

Decision Aid Research: Enter PCORI

This week, I received an announcement from the Patient Centered Outcomes Research Institute that they were funding research into testing a decision aid to help parents figure out what to do when their child has appendicitis. It’s a step in the right direction, but its ultimate value will depend on how widely it is used in the real world.

Decision aids purport to present the options to patients and/or caregivers so that patients can make the decisions that best suit them, based on their personal preferences, the science, and the uncertainties. In the past, they have been introduced when procedures are widely used, costly, when a paradigm shift in medicine is emerging, and when the best strategy seems debatable. Decision aids have been used for things like deciding what to do in the face of a diagnosis of prostate or breast cancer or whether or not to have joint (hip or knee) replacement.

Decision aids have been linked to more satisfactory outcomes, but I hardly think that they will provide the nexus of change in appendix care. I have seen no evidence that they are even used in the institutions that develop them. Nonetheless, they are a start.

A hellufa lot more public education will likely be needed to shift medical practice. I am sure that Rose Kushner and the women’s movement had more impact on reducing unnecessary total mastectomies than decision aids would have, but all is valuable.

The Decline of Surgery: A Moving Target

Robert Colgrove, MD, Division of Infectious Diseases, Mount Auburn Hospital, and Assistant Professor of Medicine, Harvard Medical school, captured the full measure of the shift towards treating appendicitis with antibiotics, rather than surgery.

“Having most of these managed medically means hundreds of thousands of operations averted in the US alone,” he said. “Along with the demise of routine tonsillectomy, it represents a huge reduction in the fraction of otherwise well children who get an operation.”

It’s not just appendectomies that are likely to decline going forward, but other surgeries are also declining as we move ahead, because medical management is showing advantages in lower complication rates, shorter recovery time, and cost.

But change will be resisted. Take gall bladders. “The most definitive way to manage cholecystitis (an inflamed gall bladder) is with cholecystectomy (removal of the gall bladder), a well validated procedure with over a century of experience to back it up,” Colgrove told me. “The best way to manage it now is very much an open question and a moving target. Classically, most people with acute cholecystitis would go on  to have recurrent and/or chronic cholecystitis, so the argument has been that you might as well just go ahead and take it out.”

Colgrove begs to differ. “As medical management improves, though, it is not at all clear that that is true any longer. Current data suggest that most people with uncomplicated cholecystitis do well with non-surgical management, but it will take a few more years before we really know the long-term implications. This is a big deal, representing a huge change in the management of one of the most common surgical procedures, so it is natural that the medical culture is taking some time to absorb it.”

From my vantage point as a public observer, it bothers me that my friend in the emergency room was set to be routed directly to surgery. When will patient safety people be available to consult with patients, some of whom might have fewer risks with an antibiotic course of action?

There are numerous other issues worthy of public discussion tied to appendicitis in kids and adults, too large for a blog post here.

My computer went belly-up this morning and I wanted this out before my short vacation. I regret the lack of links on this post, more comprehensive attention to the latest research, and the role of excessive imaging in evaluating appendicitis – topics covered previously here.

Please share your point of view in the comments below. We need a movement to move practice rationally forward.

 

 

 

 

AARP: Stakeholder for Waste and Moneyed Interests?

Laura Newman
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AARP, you lost whatever presumed credibility you thought you had with one article in the current issue of your magazine. I am talking about the hard copy of “All the President’s Scans: Our Commander in Chief Regularly Gets An Extensive Physical: Should You?” – part of your Spring 2016 Health Special in AARP: The Magazine, out this weekend. The hard copy is far more slick and glossy than what’s online, replete with pics of the three most recent presidents getting comprehensive physicals for everything under the sun, with smiles on their faces. These were not online. BTW, readers, you can get a copy of it at your local library if you don’t see it at your doctor’s office or are not getting it as an AARP member. Readers note: to get a Medicare Supplement, AARP requires that you join AARP.

 

Pitching High

 

Readers over age 50 (AARP’s target audience) might be tempted to look for an executive physical after reading this article. AARP tells you right away where to go for it in the first paragraph: “Cooper Clinic, Cleveland Clinic, UCLA, Duke and many other major hospitals offer them,” the author writes, warning you that “you could pay upward of $2,000 to $3,000 out of pocket for this.”

Like concierge care before this, executive physicals can embellish a doctor’s base considerably and enlarge what people pay for healthcare. First, a sliver of the upper middle class is conned to pay for these tests because, after all, what’s more important than your health? Pretty soon, demand increases broadly and prices go up for all.

As Good as a Cruise

The nuts and bolts of this executive physical are written about like brochures for a cruise. Nothing but upbeat information, you’ll find here. No downsides. It’s clear that AARP will satisfy many of its funders: for example, academic medical centers, providers looking for volume, and purveyors of imaging and screening tests. But those groups have their own stake and it conflicts with that of aging Americans, no matter what their health status.

Here’s the potpourri of tests that AARP claims “could help” you and provide superlative care:

  • Blood pressure readings taken all day long;
  • Blood test and urinalysis;
  • A thorough head-to-toe physical exam instead of the “old-fashioned once-over;”
  • Specialist exams all done in one day;
  • Multi-expert Q&As;
  • Body fat tests;
  • Cancer screenings, including mammography, colon, and PSA – and even a total-body CT scan, with the caveat that “some detractors think that ultra-early detection can lead to unnecessary treatments.”
  • Eye exams, which could lead you to “new medications that may help stop the spread of macular degeneration, one of the leading causes of blindness in older people” and blood vessel changes in the eyes, suggestive of uncontrolled hypertension.
  • Strength and flexibility assessment, which can lead you to physical therapy for pain relief, balance improvement, and strength improvement;
  • A stress test – EKG showing early heart problems;
  • A sit-down to summarize all the above.

Harm and The “Detractors”

The absence of attention to how so many of these tests have been demonstrated to be wasteful and even harmful is concerning.

AARP, you owe it to your readers to not masquerade advertisements as journalism. Aging Americans have shrinking pocketbooks and this “advice” is a disservice to readers. You scoff at the so-called “detractors,” as if they are few when they are many, completely overlooking the body of scientific research, clinical practice guidelines, and state of knowledge about these tests, which many, as opposed to few, question. Major health authorities question many of these tests, discussed a bit in this blog in numerous posts, and many other places. Overuse is concerning, harms are unacceptable.

For policymakers looking for stakeholders to represent aging Americans, please look outside of AARP. It does not represent us. I submit that AARP’s voice is with waste and the moneyed interests in healthcare, the providers, the establishment, and white Americans aspiring to be part of it.

 

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Readers might be interested in more nuanced discussion of these issues, as covered previously in this blog:

Cardiovascular Care and the Bush Effect

MR Imaging, Electronic Test Ordering Creates Waste

Back Pain Trends Worth Reversing

 What’s Next for Prostate Cancer Screening and Treatment?

Caveat Emptor: Testosterone Replacement Therapy Ads Soar

 

..and many more.

 

Finally, my shameless self-promotion here, but PLEASE take this seriously.

 

I need more paid, honest work to do! Please contact me! I am not ready to retire.

 

Economic Repercussions Prove Powerful in Stopping Hateful Public Health/Quality of Life Laws

Laura Newman
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It’s hard to keep up with the regressive state laws that threaten the people’s health and quality of life. Women, LGBT individuals, and people of color are popular targets. There may be a silver lining though. Just this morning, the NY Times reported corporate sponsors are thinking twice as groups mobilize to #dumpTrump, demanding that corporations separate themselves from Trump and the Republican National Convention. Coke already shrunk its $  substantially. More sponsors are expected to join in. Kind of makes me hungry for a Coke, all that sugar and all. This is special.

Economic boycotts have also been announced following North Carolina’s passage of the egregious HB2, which eliminates all new LGBT protections.  Although it’s been oversimplified into the “bathroom bill”because it disallows transgender people from entering bathrooms of the gender they identify with,it is more wide-reaching, and also takes away legal protections for LGBT individuals in the state. Last February, Charlotte NC passed a nondiscrimination ordinance. That will be made moot with NC Governor Pat McCrory signing the law.

New York State, Vermont, Washington, the City of Seattle, have announced boycotts against the state, and by the time you read this, we’ll see many more. The City of Atlanta has come out punching, saying the NBA’s All-Star Game should be moved out of Charlotte to Atlanta. Tourism, sports money are at stake.

North Carolina is already facing economic woes as a result of its outrageous positions on abortion rights. The Women’s Right to Know Act, passed in 2011, forced women opting for abortions to listen to a narrated ultrasound within 4 hours of a scheduled abortion. The good news is that the State lost a Federal lawsuit to stop this, and they now must pay out $1 million from savings in an emergency fund for legal fees, according to a News & Observer report.

Economic sanctions are proving  a lever for change, for getting corporations on the side of the people’s health. Interestingly, Atlanta was at risk of losing rights to the upcoming Super Bowl, given fair warning that passage of its regressive anti-LGBT bill would have repercussions. Then, last week, that bill was not signed into law, a victory for the people of Georgia, and LGBT health and safety.

I always think about the people in states proposing regressive legislation. The Moral Monday movement in North Carolina has been out front for quite awhile objecting to these horrendous laws that harm the public’s health. I applaud the movement. Although I wish that there was a better way than boycotts, I have to say I am delighted that people have been organizing successfully, that businesses are taking note, and that we just might stem the tide of the nasty rhetoric and legislation afoot in many parts of this nation.

Do you have thoughts on how we can restore protections now endangered? Please join the discussion below.