BMJ, 24 February 2015
“Irrational drug prescribing, kickbacks for referrals, and unnecessary investigations & surgical procedures” – testimonies from 78 doctors on the malaise afflicting India’s private healthcare system are part of a book written by Dr Arun Gadre. This commentary in BMJ titled “India’s private healthcare sector treats patients as revenue generators” gives an indication to the extent, intensity and the near-inevitability of these practices. Clichéd, but Shankar-KamalHassan were spot on in describing why it would be difficult to stem the rot. Dishonesty is so omnipresent, that we as a society have stooped low enough to accept it as a virtue. The state, the big brother who’s supposed to watch over, itself is the perpetrator. How else to explain government medical colleges juggling teaching faculty and movable infrastructure in the name of “deputation” to falsely get through MCI inspections. Coming back… the author of this article does suggest ” the only solution for India would be accountable social regulation of the private medical sector and the movement towards a combination of social insurance and a tax based system for universal healthcare”. Amen.
Annals of Internal Medicine, February 2015
Nutritional advice to patients with pressure ulcers have more similarities to MS Dhoni’s decisions on-field than James Watt’s energy calculations. Impromptu, I-believe-in-my-logic decisions that wouldn’t count as science. This blinded randomized trial “A Nutritional formula enriched with Arginine, Zinc and Antioxidants for the healing of pressure ulcers” tries to make sense of the issue. 200 patients recruited from 7 centers. Great effort. But I can’t understand why they chose to end the study at 8 weeks, instead of waiting until complete healing of ulcers, which is what matters. For what it’s worth, supplementation did seem to help. Needs work though. #thesisalert
NEJM, 11 February 2015
Acute stroke management with thrombolysis is a mixed bag. Recent systematic reviews could not make up their mind on the specifics or on whether benefits clearly outweighed the risks. This new RCT on “Rapid Endovascular Treatment of Ischmic Stroke” takes sides. In fact, the study had to be halted midway since the treatment was found to be definitely more beneficial than controls. The abstract conclusion, for a change, is well-worded, describing clearly the population to which the results could be extrapolated, and is grounded in facts “Among patients with acute ischemic stroke with a proximal vessel occlusion, a small infarct core, and moderate-to-good collateral circulation, rapid endovascular treatment improved functional outcomes and reduced mortality.”
JAMA, 27 Jan 2015
I’ve known healthcare professionals and patients who have blind immense faith on topical antimicrobials Povidone Iodine (Betadine) and Chlorhexidine, so much so that I won’t be surprised if they add a bit of the conspicuously colored fluid to their food. I wonder if this article “Chlorhexidine bathing and health care-associated infections” would make at least a dent in their belief. “…daily bathing with chlorhexidine DID NOT REDUCE the incidence of health care–associated infections including central line associated blood stream infections, catheter associated urinary tract infections, ventilator-associated pneumonia, or C difficile. These findings do not support daily bathing of critically ill patients with chlorhexidine”
From the mainstream media
“My Own Life” is a #NYT article by Oliver Sacks, the neurologist author of the unmistakably titled book “The man who mistook his wife for a hat“. He says he has metastatic malignancy, and ponders aloud on the life he has lived. “I cannot pretend I am without fear. But my predominant feeling is one of gratitude. I have loved and been loved; I have been given much and I have given something in return; I have read and traveled and thought and written…Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure”. Sounds like words of a man who has made peace with life.
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Liked in twitter: Ben Goldacre at his usual irreverant best
Rehab Journal Review 