Drugs/Medical Archive
Should Surgeons be Trusted after All-Nighters?
July 25th, 2011. By Hunter West
Say your doctor was on call all night the night before your scheduled 6 a.m. surgery. Would you still want to go under the knife?
It has long been debated that the effects of sleep deprivation can be just as harmful—and just as much an impairment—as that delivered from alcohol, or drugs. Bottom line: when we’re tired, we screw up.
You run off the road while driving, your reflexes are slower. Worse, when you try to counter the fog in your brain and the yawn on your face with copious amounts of caffeine or other stimulants, you have reflexes unsupported by studied thought—a pure reactive state, with little depth or substance from a sleep-deprived brain straining to carry on with the aid of chemicals in the place of rest.
So why is there not more dialog on this with regard to the medical profession and medical errors?
Recently, the Canadian Medical Association Journal (CMAJ) published an editorial on the sleepy doctor syndrome. Not only did the CMAJ target the problem at the doctor and hospital level, it also called upon legislators to develop national standards in the regulated health care industry to protect patients from sleepy docs.
There is valid reason for this concern.
Beyond the temptation for some doctors to wear sleep deprivation as a badge of honor—or hospitals having to make do with fewer staff amidst the realities of a health care system under siege and shrinking health care dollars—are studies that paint an alarming picture of both where we are, and where we’re headed.
According to a story in the Montreal Gazette (5/25/11), studies have shown a near doubling in the rate of complications when surgeons operate with fewer than six hours of sleep—usually following a night on call.
Those complications have been found to include injuries to organs (a slip of the scalpel), and massive hemorrhaging. Such events can put a patient’s life in immediate danger, or affect their health over the long term.
The doctor, in contrast, goes home to a pillow and beyond feeling regret for the error, is not required to live with the consequences of that error for a lifetime. Unless, of course, a medical malpractice lawsuit is filed.
Mistakes happen, and to err is human nature. But in publishing its editorial, the CMAJ suggested that an already serious problem is about to get worse given the increasing complexities of the health care field. “Unprecedented” demands are placed on a doctor’s physical and cognitive health, as a result.
“Those of us who remain overconfident that we can continue to perform our duties properly with inadequate sleep should imagine the reaction if we were made to seek informed consent from each of our patients to accept treatment under these conditions,” state the authors, adding that working while sleep deprived is neither “normal nor acceptable.”
The authors also point out that—in Canada at least—limits on how long a resident, intern or medical student can go without sleep are not extended to practicing doctors, who often work without supervision and are often older and thus even more susceptible to the effects of lack of sleep.
Such situations are ripe for malpractice lawsuits—and doctors, together with the hospitals that employ them, need to be cognizant of that fact. Errors are unavoidable—but they can me managed and mitigated.
There are already efforts underway in other areas of the health care system. Increasing the use of checks and balances—akin to the checklist in the airline cockpit—helps ensure that the surgeon is operating on the correct patient and is performing the correct procedure in, or on the requisite are of the patient’s body.
Similar-looking labels on drug containers are being changed to avoid confusion in the pharmacy. Lawsuits, together with media scrutiny and public outrage, have helped to motivate the powers that be into action.
What of sleepy docs? Will a spate of lawsuits prompt the health care industry to action beyond mere debate? Lawsuits might be business for the lawyers, and monetary settlements necessary for the affected plaintiffs. But most would prefer to have been spared amputation of the wrong leg, or a scalpel nick that brought on a lifetime of pain or complication, all because the doctor yawned at the wrong time, or wasn’t in total control of his movements just because he was so bloody tired.
Maybe you can collect garbage on a few hours sleep. But I, for one, don’t want anyone going near me with a knife if they might be tired and sleep deprived.
Don’t be a hero. Sign out, go to bed, and let someone else do it. And somebody, somewhere needs to come up with a system that guarantees that.
Infographic: 5 Hip Replacement Options, 1 with Lawsuits
July 24th, 2011. By AbiK
With the recent FDA approval of the DePuy Pinnacle CoMplete Acetabular Hip, we thought it might be helpful to put it all down on an infographic that shows the different types of hip implant components and which one has been the target of hip replacement lawsuits. Find more information on the metal-on-metal (MoM) DePuy ASR hip replacement here.
Loughner Anti-Psychotic Ruling a Travesty for ADHD Parents
July 13th, 2011. By AbiK
Here’s a little quiz: Who do you Think was Forced to Take Psych Drugs?
Parents like Jim Kaiser and Maryanne Godboldo are undoubtedly outraged by the court ruling allowing alleged murderer Jared Loughner—the seeming wacko who is not only alleged to have killed 6 people and injured 13 others including Rep. Gabrielle Giffords but also has been diagnosed with schizophrenia and is currently housed in a federal mental hospital, unfit to stand trial–to refuse antipsychotic medication. HE can refuse to take the antipsychotic medicine if he wants—because it’s against his rights!
Yes, I’m sure according to the letter of the law, it is against his rights. But what about the parents of ADHD children—as with Jim Kaiser whose son Ben (above right) was forced to take Adderall? Or what about Maryanne Godboldo who raised a red flag after noticing her daughter had behavioral changes after some immunizations only to be forced to give her child psychotropic drugs—and when she fought that, her child was forcibly removed from her home? It’s ok to mandate drugs to our children, but not to an alleged murderer who’s been diagnosed with schizophrenia and seen as a threat to others?
Think about it—this guy can just say “no thanks” to a stabilizing anti-psychotic–while putting the safety of medical staff in jeopardy and basically making a mockery out of the victims’ plight—but you might be forced to drug your child. What’s wrong with this picture folks?
Medtronic Under Fire with Questions of Financial Conflict
July 7th, 2011. By Hunter West
A blockbuster investigation by some print media outlets has spurred a US Senate Finance committee to start beating the bushes once again around the medical devices industry.
There are many questions:
How safe are the products that wind up in your body?
What do the manufacturers know about potential safety issues, but aren’t telling?
Why is it okay for a doctor or surgeon to be paid by a medical device manufacturer? And can you really trust what a doctor [who is paid by the device maker] says about that device?
Do you feel like a guinea pig?
It was revealed yesterday through a series of articles published by the Milwaukee Journal Sentinel and MedPage Today that there is some controversy surrounding Medtronic Infuse, a popular bioagent known as bone morphogenetic protein-2, designed to foster bone growth required for spinal fusions.
Infuse was approved by the US Food and Drug Administration (FDA) in 2002 and doctors love it. It’s easy to work with. And you don’t have to harvest a patient’s own bone from elsewhere, in order to accomplish the surgery. You have to love something that allows a surgery to proceed faster, and more easily.
But here’s the rub—and the reason for the Senate Committee investigation. It seems that a cadre of surgeons around the country were paid by the device manufacturer, Medtronic. Those same surgeons with financial ties to Medtronic were involved both in the clinical trials for Infuse, Read the rest of this entry »
Topamax Weight Loss a Risky Diet
June 30th, 2011. By AbiK
It’s not news that Topamax is prescribed for a number of conditions—migraine is one. And, given that migraines typically affect women more frequently than men, a Topamax prescription should raise a questioning eyebrow in women of child-bearing age. After all, Topamax has been linked to birth defects—oral defects such as cleft lip and cleft palate. So much so that the FDA recently switched the Topamax pregnancy category from a Pregnancy Category C to a Pregnancy Category D drug.
The beauty of pregnancy migraines, however, is that for many women, they cease to exist or at least diminish in their frequency or severity. And, ideally, a woman who has been given a Topamax migraine prescription then stops taking the drug as there is no apparent need for it. Unfortunately, as any migraine sufferer will tell you, it’s not that simple. If you get migraines, you know that the pain and nausea is enough to make you wish for a fate not less than death at times—just for the anticipated peaceful relief. So would a woman who wants nothing less than to avoid a migraine willingly stop taking Topamax on the mere hope that her migraines have subsided due to temporary hormonal changes from pregnancy? It’s questionable.
And, keep in mind, unlike some migraine medications, Topamax is taken daily to prevent the headache—it’s not taken ad hoc once a migraine starts to relieve pain. Once you’re on it, you’re on it.
Migraines aside, one condition that most all women have a hard time with during pregnancy is weight gain. There is no way around it. And chances are, if you’ve been pregnant yourself, you Read the rest of this entry »
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