The toll taken by medical mistakes burst into public attention with a 1999 report called To Err Is Human from the U.S. Institute of Medicine. The report estimated that between 44,000 and 98,000 people die each year as a result of preventable medical errors. Such errors can be headline grabbers, like the death of Boston Globe columnist Betsy Lehman from an overdose during chemotherapy. The safety of hospital stays and encounters with health-care providers got a boost today with the publication of 22 evidence-based “patient safety strategies.” Although most focus on care that takes place in hospitals, they extend to almost all interactions between individuals and their doctors, nurses, and other care providers. Very few of the safety practices are expensive, high-tech interventions. Instead, they are almost old-fashioned efforts that aim to improve communication between health-care providers and their patients, and to improve the practice of medicine rather than the art of medicine. The theme of all of these interventions is to create systems that help caregivers follow every step that is known to improve patient care, and to avoid relying on fallible human memory. To err may be human, but it is also often preventable.
Patrick J. Skerrett
Posts by Patrick J. Skerrett
A pacemaker-like device that stimulates the brain can help control some of the muscular problems brought on by Parkinson’s disease, the second most common neurodegenerative problem in America. A report in tomorrow’s New England Journal of Medicine may prompt doctors to recommend its use sooner rather than later. For more than a decade, deep-brain stimulation has been used to help control Parkinson’s symptoms. It involves placing a tiny wire called a lead (pronounced leed) in the part of the brain that controls movement and a matchbook-sized stimulator under the skin below the collarbone. The lead and stimulator are connected to each other by a second wire that runs under the skin of the shoulder, neck, and head. The device emits small pulses of electricity that help coordinate movement. Deep-brain stimulation traditionally isn’t used until a person has lived with Parkinson’s for a decade or more. The new report in the NEJM will give doctors more leeway to use this therapy earlier in people with Parkinson’s.
To get or stay healthy, many people focus on exercising more, eating better, or quitting smoking. Getting recommended vaccinations is another relatively simple strategy for health that an alarming number of Americans overlook. Vaccination isn’t just for kids. Adults should get immunized against infectious agents that cause the flu, pneumonia, whooping cough (pertussis), shingles (herpes zoster), and more. The latest schedule for adult immunization has been published in the Annals of Internal Medicine. It now recommends adding a second anti-pneumonia vaccine for people with compromised immune systems. It also says that all adults age 65 and older should get the tetanus, diphtheria, and pertussis (Tdap) vaccine, as should pregnant women with each pregnancy. When it comes to adult immunization, Americans aren’t doing very well. One-third of older Americans don’t get the pneumococcal vaccine, 84% don’t get the shingles vaccine, and 87% don’t get the tetanus, diphtheria, and pertussis vaccine. In addition to protecting yourself from an infectious disease, immunization also protects others.
As a huge, snowy Nor’easter barrels into New England, I’m thinking about all the shoveling I’ll be doing over the next couple days. Luckily I have three teenagers to help. But now that I’m of an AARP age, I have to be more mindful of the cardiovascular effects of shoveling. Snow shoveling is a known trigger for heart attacks. Emergency rooms in the snowbelt gear up for extra cases during significant snow storms. What’s the connection? Many people who shovel snow rarely exercise. Picking up a shovel and moving hundreds of pounds of snow, particularly after doing nothing physical for several months, can put a big strain on the heart. Pushing a heavy snow blower can do the same thing. Cold weather also contributes. Tips for protecting the heart include shoveling many light loads instead of fewer heavy ones, taking frequent breaks, and hiring a teenager.
File this under “if a little bit is good, a lot isn’t necessarily better:” taking high-dose vitamin C appears to double a man’s risk of developing painful kidney stones. In an article published yesterday in JAMA Internal Medicine, Swedish researchers detail a connection between kidney stone formation and vitamin C supplements among more than 23,000 Swedish men. Over an 11-year period, about 2% of the men developed kidney stones. Men who reported taking vitamin C supplements were twice as likely to have experienced the misery of kidney stones. Use of a standard multivitamin didn’t seem to up the risk. Many people believe that extra vitamin C can prevent colds, supercharge the immune system, detoxify the body, protect the heart, fight cancer, and more. To date, though, the evidence doesn’t support claims that extra vitamin C is helpful. If high-dose vitamin C doesn’t improve health, then any hazard from it, even a small one, is too much.
“Whole grain” has become a healthy eating buzzphrase, and food companies aren’t shy about using it to entice us to buy products. Browse the bread, cereal, or chip aisle of your favorite grocery store and you’ll see what I mean. Last year, nearly 3,400 new whole-grain products were launched, compared with just 264 in 2001. And a poll by the International Food Information Council showed that 75% of those surveyed said they were trying to eat more whole grains, while 67% said the presence of whole grains was important when buying packaged foods. But some of the products we buy may not deliver all the healthful whole-grain goodness we’re expecting. Identifying a healthful whole-grain food can be tricky. A new study from the Harvard School of Public Health says the best way is to choose foods that have at least one gram of fiber for every 10 grams of carbohydrate. Fiber and carbs are both listed on the nutrition label.
It’s shaping up to be a banner year for the flu. The City of Boston just declared a public health emergency, with 700 cases of the flu reported so far this season, compared to just 70 cases last year. Four Boston residents, all elderly, have died. A similar spike in flu is happening all around the country. According to the federal Centers for Disease Control and Prevention, this year’s flu season is shaping up to be a bad one. By the end of December, the flu was widespread in 41 states. The CDC says that more than 2,000 people have been hospitalized so far; scores of adults have died, as well as 18 children. One way to keep from getting the flu is to get the flu vaccine. (Almost everyone age 6 months and older should be vaccinated.) If you haven’t already done this, it isn’t too late. For more information about the flu, visit Harvard Health Publication’s Flu Resource Center at www.health.harvard.edu/flu
What harm can having too little of a vitamin do? Consider this: Over the course of two months, a 62-year-old man developed numbness and a “pins and needles” sensation in his hands, had trouble walking, experienced severe joint pain, began turning yellow, and became progressively short of breath. The cause was lack of vitamin B12 in his bloodstream, according to a case report from Harvard-affiliated Massachusetts General Hospital published in The New England Journal of Medicine. It could have been worse—a severe vitamin B12 deficiency can lead to deep depression, paranoia and delusions, memory loss, incontinence, loss of taste and smell, and more, according to another article in tomorrow’s New England Journal. Some people, like strict vegetarians, don’t take in enough vitamin B12 every days. Others, like many older people and those who have had weight-loss surgery or live with celiac disease or other digestive condition don’t absorb enough of the vitamin. Daily supplements can help.
Greater use of generic drugs could save the healthcare system—and American consumers—billions of dollars that would be better spent elsewhere. What’s holding us back? Some consumers are reluctant to use generic medications, thinking they are inferior to “the real thing.” Doctors are also a big part of the problem. Up to half of physicians hold negative perceptions about generic drugs. And a new study to be published in tomorrow’s JAMA Internal Medicine shows that about 4 in 10 doctors sometimes or often prescribe a brand-name drug just because their patients ask for it. Prescribing a brand-name drug when a generic is available is a huge source of wasteful spending that could easily be prevented. People ask for brand-name drugs because they have heard of them through advertising or word of mouth, while their generic alternatives generally aren’t advertised. Doctors could help save billions of dollars by just saying “no.”
If you’ve ever nodded off while driving, you aren’t alone. In a new report from the Centers for Disease Control and Prevention, 4.2% of Americans admitted to falling asleep while driving at least once in the previous month. The just-published survey, conducted in 19 states and the District of Columbia, found the sleepiest drivers in Texas (6.1%) and Hawaii (5.7%), and the most alert ones in Oregon (2.5%) and the District of Columbia (2.6%). Individuals most likely to have fallen asleep while driving were those who said they unintentionally fell asleep during the daytime at least once during the preceding month, those who said they snore at night, and those who reported sleeping less than six hours a night. Keep in mind that these numbers reflect only the percentage of people who were aware they had fallen asleep. They don’t include those who fell asleep while driving without recognizing that had happened.