Archive for the 'Healthcare Quality' Category
February 16th, 2012 by Trisha Torrey
Want to make millions of dollars quickly while risking only a few months in prison if (and that’s a big IF) you’re caught? It’s not difficult at all. Just set yourself up as a distributor of counterfeit drugs in the United States.
This week’s announcement by the FDA that a counterfeit version of Avastin, a chemotherapy drug that is used for several kinds of cancers and tumors (lung cancer, kidney cancer, colon and rectum cancers – but no longer for breast cancer since approval was removed last year) has been found across the country, infused into the national drug supply, raises plenty of questions about how that could possibly happen.
It was followed by an interesting article in USA Today which partially answers the question. Counterfeiting is a multi-billion dollar business that is on the rise because it’s so lucrative, and because the penalties are so… well… inconsequential. I mean – would you be willing to spend no more than six months in jail if you could make millions of dollars for use when you got out? (Even if you would answer no! I don’t want to go to jail!… I’ll ask you this…. what if your child had treatable cancer and you had no insurance? Just sayin’ …)
Avastin isn’t the only drug that may be counterfeited. Any high cost drug that can be watered down, or manufactured to “look” right even if it is manufactured without its expensive ingredients, is a target for counterfeiters. Lipitor and Viagra are probably the most apt to be counterfeit, but others like drugs used to treat HIV and AIDs, or diabetic drugs, or weight loss drugs, are likely targets for counterfeiters, too.
So what happens if you are somehow treated using a counterfeit instead of the real drug? Maybe nothing. Or maybe you die. Or anything in between. The problem is, for the most part, we patients have very few ways we can detect whether a drug is real or fake.
Katherine Eban, in her book, Dangerous Doses, tells the stories of people who died from receiving infusions of counterfeit Procrit. The conventional wisdom on this most recent discovery of fake Avastin is that there was nothing in the counterfeit version that was dangerous, and it’s difficult to tell within a regimen of 18-20 doses a cancer patient might receive over six months whether one “missed” infusion of the active ingredients has a long-term effect.
The bigger picture problem is that our drug supply is not being well enough protected by the FDA, which is tasked with protecting us. The FDA has no backbone when it comes to protecting us from bogus, counterfeit drug distributors who appear to be selling “real” drugs, but target greedy doctors, pharmacies and hospitals that are so willing to buy “discounted” drugs for their patients, knowing that there will be more profit in their reimbursements. Experts estimate that about 1% of our drug supply is counterfeit. That means that 1 out of every 100 administered drugs may be counterfeit, too.
One answer to this is an electronic pedigree system, meaning, from the time the drug is manufactured, until it is given to the patient, it is followed and logged using a bar code type system. If such a system was in place, then even us patients would have a way to double check that the drugs being given to us are the real drugs they are supposed to be.
So why doesn’t the FDA insist on the development of such a system? Well, actually, they have. But again, they have no teeth, and so far, no backbone. Every time they raise the issue, the drug companies and drug distributors begin to wail about the added cost to the system. (Surprise! Follow the money!) And so, nothing gets done.
Like other issues in healthcare, it looks like little will happen to improve this system until something horrible befalls someone famous; someone who can actually override the special interests in Washington and insist on development of this electronic pedigree system.
Until then, here is information to help us patients do what we can to protect ourselves from counterfeit drugs.
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December 8th, 2011 by Trisha Torrey
This column first appeared
in the Syracuse Post Standard
December 6, 2011
It’s that time of year again. The holidays, of course. But also the end of the tax year, when charities, including groups like cancer societies or hospital foundations, are pleading for donations.
Each year in December my husband and I make contributions to the charities we think are important, many of which are health-related. Last year money was tight, and we knew we would either have to cut back on how much we donated, or leave some organizations off our list.
To help us make those difficult decisions, I did some background research on each of the charities we ordinarily support. I was surprised at what I found! And learned some tips to share with you, too.
First, I learned that when children need specialized cancer treatment, they will get the same treatment whether they live in Paris, Tokyo, Sydney – or Syracuse. Pediatric oncologists worldwide share their research and successes to the benefit of children everywhere.
I had to ask myself – why would we send a contribution to a children’s hospital out of state? Since children receive the same specialized treatments, doesn’t it make more sense to donate in our own backyards? I’m sure those famous children’s hospitals provide excellent care. But if my child was sick, and I had to stay with her in a city far away, how would I get to work? Where would I stay? Bottom line – we decided to donate to our local children’s hospital, knowing local kids would get the great care they need.
Next up – family interests. Within my husband’s family or mine, we have loved ones who have dealt with Alzheimer’s, diabetes, lymphoma and breast cancer. We have always donated to those very large, national charitable foundations, thinking our money was going toward education, research, and of course, a cure.
Not so fast! It turns out that not all charitable foundations are equal – including those we’ve sent money to each year. I discovered that some charities are actually quite questionable. For example, too much of their money goes toward “undetermined” administrative costs. Or worse, only a small percentage of their budget goes toward their stated goals of education, patient support or research. One very well known charity is spending the bulk of its donations on legal fees, suing smaller charities!
Based on that information, we decided against supporting two of the organizations we’ve sent money to for years.
As a result of this process, I realized that if more of us were choosier about our donations, health-related or not, the most effective and efficient organizations would have more funds to really make progress with their missions – a benefit for everyone.
You may want to review your charity choices, too, to be sure your donations have the best chance of accomplishing the goals you think are important.
Here are some additional resources for
choosing the best charities for your donor dollars:
How to Donate Money to Health and Disease Charities
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November 23rd, 2011 by Trisha Torrey
This column first appeared
in the Syracuse Post Standard
November 22, 2011
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You may be among the millions of Americans who will travel during the upcoming holidays. Travel takes you out of your normal environment and disturbs your routine. If you have health issues, like a chronic disease, an injury, or even a short-term illness, it’s smart to prepare ahead of time for those changes and accommodate for them where possible. You’ll want to be sure your travel doesn’t upset your health, and your health doesn’t upset your travel.
Drugs, supplements and supplies: Pack enough to cover the days you’ll be away, plus extra, in case flights are delayed or a blizzard closes the roads. If you fly, remember that airlines can lose checked bags, so keep all medical supplies with you in your carry-on bag. Any time difference at your destination may require an adjustment of your drug routine. Make yourself a chart ahead of time to keep your regimen on schedule.
Airport security: The TSA has strict rules about what can, or cannot go through security. Medications, oxygen, inhalers and other medical items must be packed in certain ways, and will be screened through x-ray machines. Go online before you fly to learn to learn how to get your medical equipment or materials through security. http://1.usa.gov/TSAMedical
Foods: Alert your host ahead of time if you have special dietary requirements, or if certain foods upset your digestion. Mention any food allergies you have or conflicts with drugs you take. Plans can be made to accommodate your needs when they are discussed ahead of time.
Contagious diseases: Of course, holiday time is often cold and flu time, too. Get your flu shot prior to travel. Wash or sanitize your hands as often as possible, and keep them away from your mouth, nose or eyes. If you are highly susceptible or your immune system is compromised, consider wearing a face mask to protect yourself from others who might be contagious. If you have a cold, then cough or sneeze into your elbow, not your hands, to prevent infecting others.
Long Distance Travel: If you’ll be sitting for great lengths of time in a car or plane, you risk potentially deadly blood clots in your legs called DVT (deep vein thrombosis.). Keep your blood circulating by taking hourly breaks to walk around and stretch.
These travel preparations will keep you healthier and will make your visit more enjoyable, too.
Here are some additional resources for
making sure you stay healthy while traveling:
• Tips for Healthy Travel
Before You Go, As You Travel, and At Your Destination
• Tips for Healthy International Travel
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October 13th, 2011 by Trisha Torrey
Please note that this column first appeared in the Syracuse Post Standard 
October 11, 2011
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In the “old” days, we could phone for a primary care doctor’s appointment in the morning, be seen right away, spend enough time with the doctor, leave with a treatment plan, and usually feel better within a day or two.
But no longer! Today it’s difficult to get an appointment, even within a few days. We sit in waiting rooms far longer than we expect. Then when we finally see the doctor, we often feel like we’re being rushed out the door.
We patients tend to blame our doctors and the way they run their practices. Why should we have to wait so long? Why won’t they spend more time with us? What’s the big hurry?
The truth is, your doctor doesn’t like today’s limited time system either. He would love nothing more than to be able to make immediate appointments, see you the moment you arrive in his office, and spend plenty of time with you, too. But the insurance reimbursement system doesn’t make that possible.
Last week I had the opportunity to work with personnel at North and Northeast Medical Centers. I was asked to help them help us patients manage this time-constrained reality we are all stuck with to improve patient satisfaction. I suggested some steps they can take to help their patients get the most from their appointments.
But the patient-provider relationship is two sided. We patients need to take our responsibilities in that relationship more seriously, too.
We can do so by preparing ahead of our appointments:
First – Write down anything that is new since your last appointment. New symptoms, new aches or pains, new supplements you’re talking, drugs another doctor has prescribed, or new triggers you’ve discovered that create problems for you. Record them along with the dates they started.
Second – Take a list of every drug and supplement you take, including brand names and dosages. Note any that will need renewal within the next 90 days. Or, instead of listing them, throw the containers into a bag and take them with you.
Third – Write down your questions. Prioritize them since you’ll only have time to ask two or three. If you have more than one medical problem, and therefore extra questions, then make an additional appointment.
Being a prepared patient will make every interface with your doctor more effective and efficient. You’ll be more likely to get what you need – a collaboration that’s beneficial to you and your doctor.
……………… ADDITIONAL RESOURCES ON THIS TOPIC ………………
Effective Patient-Doctor Communications
Why Do I Wait So Long for my Doctor Appointment?
Are You Prepared for Your Doctor Appointment?
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