Domo arigato, Dr. Roboto — Maybe
Hospitals across Oklahoma City have invested in a da Vinci surgical robot, a highly marketed robot that can be used to perform a variety of surgeries. I’ve interviewed several doctors who use the robot to perform surgeries, and many of them rave about it.
They say patients recover faster, have fewer complications and leave the hospital faster than patients who don’t have the same kinds of surgeries using the robot.
But there’s a catch to some of their claims — comprehensive data to back it up.
As this article points out, recently published medical research has found that robotic surgery might not always prove to be more beneficial.
In the dozen years since the Da Vinci robot has been approved for surgeries in the United States, it’s been embraced by health care providers and patients alike. Surgeons routinely use the multi-armed metal assistant to remove cancerous prostate glands and uteruses, repair heart valves and perform gastric bypass operations, among many other procedures.
Lately a key study and reports of problems have raised questions about robotic surgery’s safety and cost-effectiveness, leading to a review of the Da Vinci system by the Food and Drug Administration and causing some experts to wonder whether the benefits of undergoing robot-assisted surgery may have been overstated.
To make any claim in medicine that one approach works better than the other, you need a study published in a medical journal that says “Yes, this is very, very true.” Actually, you probably need several studies by different academic institutes that agree and say, “Yes, that study is very, very true, and here’s what we found that says it’s still very, very true.”
Surgeons I’ve talked to with say the da Vinci robot allows them to operate inside a patient and affect the least amount of tissue while inside. And so far, the debate continues, with the U.S. Food and Drug Administration currently reviewing the system.
Complications can occur with any type of surgery, and so far it’s unclear if they are more common in robotic operations. That’s part of what the FDA is trying to find out.
Intuitive Surgical disputes there’s been a true increase in problems and says the rise reflects a change it made last year in the way it reports incidents.
The da Vinci system “has an excellent safety record with over 1.5 million surgeries performed globally, and total adverse event rates have remained low and in line with historical trends,” said company spokeswoman Angela Wonson.
But an upcoming research paper suggests that problems linked with robotic surgery are underreported. They include cases with “catastrophic complications,” said Dr. Martin Makary, a Johns Hopkins surgeon who co-authored the paper.
West Nile virus: An ongoing struggle
This past summer, Oklahoma saw more residents die from West Nile virus than ever before.
West Nile virus season ended a few months ago in Oklahoma, but many Oklahomans are still working to recover from the virus.
For the past few months, I’ve been writing about Bob Matthews, an Oklahoma City resident who contracted West Nile virus and was paralyzed because of it.
Bob Matthews is comforted by his wife, BJ Matthews, as he continues to recover from the effects of West Nile Virus in Oklahoma City, Friday, August 10, 2012. Photo by Bryan Terry, The Oklahoman
Medicaid expansion: A visual aid
Like many people, I’m a visual learner.
And because of that, I can get bored quickly when you start spouting out tons of numbers.
So, here’s a visual aid of what Medicaid expansion would look like in Oklahoma. (more…)
Oklahoma ranks last again
After taking a hiatus from The Medicine Bag, I have returned … with a question.
Do you think it’s fair and/or accurate to see Oklahoma ranked at or near the bottom of, well, just about every study of health that comes our way? We can’t be worst in everything health-related, can we?
I say this after reading about Wednesday’s report from The Commonwealth Fund. The nonprofit ranked children’s health in states on 13 indicators that included access to and quality of care, outcomes, equity and cost.
Oklahoma pulled up the rear. Fifty-first. Behind the District of Columbia and Mississippi. Leading the rankings were Iowa, Vermont, Maine, Massachusetts and New Hampshire.
Now, I know the devil’s in the details, and I admit I haven’t looked at the methodology of this report. I usually do, however, which is why I ask about the fairness of all this. I imagine this report would pass muster if you agree what it measures accurately sums up the state of children’s health.
Ah, here’s where it gets tricky: Are the measures used fair? Are small differences in rates or percentages blown out of proportion? Is the information current, or as current as possible?
See the state’s “scorecard” for yourself here.
The interesting thing about these reports is they are all largely slicing and dicing the same data. Sometimes it gets hard to tell them apart.
Anyone who honestly assesses the state’s health will find huge problems. But last or near-last every time? Perhaps I’m becoming desensitized, but my reaction is getting to be “C’mon!?!”
What’s yours? Tell me what you think by posting a comment on this blog.
Jeff Raymond, Medical Writer
The cost to retire
Is retirement going to be a luxury for thirty- and forty- something workers? I increasingly think it will be, and a new estimate from investment giant Fidelity does nothing to dispel that.
A 65-year-old-couple retiring this year will need approximately $225K to cover medical costs in retirement, Fidelity estimates. Let’s not lose sight of the fact that this is in addition to the coverage available under Medicare, which may itself not be available when I and others retire.
The hypothetical retirees will still have to have enough money to live, either independently or in long-term care.
Perhaps what’s even more sobering than the estimate is its growth since 2002 — 41 percent.
The roughly 6 percent annual growth in the Fidelity projection about matches the growth of my 401K fund during a slow year. I know that doesn’t take into account contribution matching and interest compounding, but I think it raises a worthwhile point nonetheless.
And health care costs show no signs of flattening or decreasing.
Does paying for retirement terrify you as much as it terrifies me? Leave me a comment at http://blog.newsok.com/health.
Fidelity recommends:
- Creating an individual retirement plan
- Starting early and maximizing opportunities to save
- Assessing health status and becoming a smarter consumer of health care
- Determining details of any employer-sponsored coverage
- Understanding the financial impact of health care costs on Social Security income
Jeff Raymond, Medical Writer
Chest pain
I worked for six months or so in the emergency room at Saint Francis Hospital and saw a number of interesting things while I was there. Among them were patients who repeatedly visited the ER complaining of chest pains but who weren’t having heart attacks.
The Agency for Healthcare Research and Quality today reported that such chest pain accounted for 16 million ER visits in 23 states in 2005. I’m not sure if Oklahoma was one of the surveyed states, but it’s nonetheless interesting. About one-fifth of the patients — 345,000 of them — were admitted for observation or treatment.
“Non-specific” chest pain was the fourth most common cause of visits to the ER. The top three were sprains and strains, bruises and other superficial injuries, and abdominal pain.
AHRQ also found:
- ER visits were almost twice as likely among those from the poorest communities compared with those from the wealthiest communities.
- Uninsured patients accounted for about 18 percent of visits.
If you ran a hospital, how would you handle an uninsured person who isn’t having a heart attack but may need observation? Visit The Medicine Bag blog at http://blog.newsok.com/health to leave a comment.
Jeff Raymond, Medical Writer
Holding on a heart attack
We Oklahomans know heart attack signs about as well as our peers. What we don’t do so well is call 911.
What gives?
A recent issue of the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report compared how much 71,994 residents of 14 states knew about heart attack symptoms and whether they knew to call 911.
Overall, awareness of all five warning signs was 31 percent. Eighty-six percent of respondents reported they would first call 911 if someone were having a heart attack. Among Oklahomans, only 81 percent would do so.
In 2005 approximately 920,000 people had heart attacks; approximately 157,000 were fatal. Fewer people would die from heart attacks if they sought medical care more quickly.
“Although emergency care and medical therapies for acute events have improved, studies have shown that the time from symptom onset to treatment overall has not decreased,” according to the report.
I’m guessing that awareness of heart attack is lacking, and people’s first reaction is to call a loved one or drive the victim to the hospital. Maybe loved ones don’t recognize what’s happening or downplay the seriousness of it. Or maybe people in some parts of the state have to wait for an ambulance to respond, making driving the heart attack victim to the hospital more of an option.
Jeff Raymond, Medical Writer
C-section stats
Almost 1 in 3 American woman had babies delivered by C-section in 2005, the Agency for Healthcare Research and Quality reports.
The number of C-sections was 38 percent less in 1995.
AHRQ also found:
- -Vaginal deliveries declined from about 3 million in 1995 to 2.9 million in 2005.
-Vaginal deliveries among women who previously had given birth via C-section dropped 60 percent –157,200 in 1995 to 62,300 in 2005.
-Hospitals charged $17.4 billion for deliveries by C-section in 2005.
The Oklahoman’s Heather Warlick wrote this story about C-sections in September.
Jeff Raymond, Medical Writer
Waiting for a liver
The need for donor livers outstrips their supply. Each year, about one-third of those with end-stage liver disease who need an organ will receive one. Some die while on the waiting list.
The February issue of Mayo Clinic Proceedings examines how the current system for allocating organs in the United States affects recipients’ outcomes.
The United Network for Organ Sharing (UNOS) oversees organ allocation. With the goal of giving organs to the most critically ill transplant candidates, UNOS adopted the MELD — Model for End-Stage Liver Disease — scoring system in 2002. The score is calculated from the results of three lab tests.
“Unlike past evaluation systems, the MELD score de-emphasizes the length of time a patient has been waiting for a donor organ. … Research has shown that although the donor liver shortage persists, implementing this allocation system has decreased the number of patients who die while waiting for donor organs,” according to a Mayo Clinic press release.
The study looked at the evaluation practices and acceptance criteria for liver transplant used by the Mayo Clinic Jacksonville Transplant Center after implementation of MELD scoring. Researchers examined medical records from 555 patients referred for liver transplants at the Jacksonville center from Jan. 1 through Dec. 31, 2005. Of these patients, 53 percent were denied for a transplant. Half of those denied were considered too early to have the procedure, while the rest were excluded because of medical conditions and psychosocial issues — poor support systems or continuing substance abuse problems, for example.
Many were subsequently accepted.
“Patients seeking referral often undergo repeated assessments by selection committees, as their eligibility can change over time or following treatment and/or changes in conditions that led to their initial exclusion,” according to the release.
Data suggest a “broad range” of patients could benefit from early referral to a transplant center, according to the release.
Basically, management of their disease and other medical and psychosocial conditions could make them transplant candidates sooner.
To read the report, click here.
People seldom realize transplant waiting lists are anything but static: They constantly change, depending on organ availability and patients’ medical states. They’re definitely moving targets. People move up, they move down; they drop off, they’re added back.
“Our study suggests that early referral for LT (liver transplant) evaluation is beneficial for reasons unrelated to the time patients spend on the LT waiting list. If patients too early for LT were evaluated but not listed, LT centers could initiate management of ESLD (end-stage liver disease) and address psychosocial issues in a sub-group of patients who could also ultimately benefit from LT,” the authors wrote.
Although not exactly the same thing, last month I wrote about this man, Dr. Ludvik Artinyan, left, who registered on organ waiting lists in California and Oklahoma. He was able to receive a liver transplant quicker by traveling to Integris Baptist Medical Center to have the procedure performed rather than having it done in Los Angeles. Because patients’ MELD scores typically are higher in California for various reasons, double-listing likely allowed the Armenia-born physician to shave months off his wait time and perhaps saved his life.
UNOS allows potential transplant recipients to be listed in multiple regions – they must meet each site’s criteria and be ready to respond to the phone call or page when an organ becomes available.
Is the current organ allocation system fair? E-mail me at jraymond@oklahoman.com or post your thoughts at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
Keeping men healthy
Statistically speaking, men will die six years sooner than women. We have higher death rates for the 15 leading causes of death.
Here are some stats from the National Center for Health Statistics:
- In 1950 the age-adjusted death rate per 100,000 men was 1,647.2.
- For women it was 1,236.
- In 2000 the rate for men was 1,053.8.
- For women it was 731.4.
- In 2004 the rate for men was 955.7.
- For women it was 679.2.
- In 1950 the death rate among men from heart disease was 697.
- For women it was 484.7.
- In 2000 the rate for men was 320.
- For women it was 210.9.
- In 2004 the rate for men was 267.9.
- For women it was 177.3.
The numbers, whether taken together or broken down by cause of death, show that while age-adjusted death rates of men and women have made huge strides, men still trail.
Check out the rest of the document here.
I bring this up to spotlight Integris Health’s annual Men’s Health University Men’s Fit Club. The program appropriately began the day after the Super Bowl. It is a weight-loss class offered just for men, of all ages. It focuses on eating habits and increasing fitness.
Men-U is a series of events throughout the year to educate men and their loved ones on how to take care of their health. Health checks such as prostate cancer screenings are featured, and then there’s the Man Card, from Integris and WWLS The Sports Animal. Cardholders earn points that can be redeemed for prizes.
The class runs through April 17 and will be every Monday from 5:30 to 7:30 p.m. at Integris Pacer Fitness Center. The cost is $240 — less for those with a Man Card. Call (405) 951-2277 or (888) 951-2277 for more information.
One reason men die earlier may be because they avoid going to the doctor. A 2007 survey of more than 1,000 men for the American Academy of Family Physicians showed almost one-third wait as long as possible before seeking medical attention.
For health and medical news and commentary, read The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
