Tagged Health Industry

Should Doctors Offer Immunotherapy To Terminal Cancer Patients? Some Are Rolling The Dice

The chance immunotherapy will help some patients is small — but not zero. “Under rules of desperation oncology, you engage in a different kind of oncology than the rational guideline thought,” says Dr. Oliver Sartor. Other doctors won’t even bring up the treatment though, arguing that scientists first must gather rigorous evidence about the benefits and pitfalls.

McKesson Absolves Itself Of Blame In Opioid Crisis, Claiming Managers ‘Worked In Earnest’ To Meet DEA Rules

But the International Brotherhood of Teamsters, which has accused the pharmaceutical wholesaler of exacerbating the opioid epidemic, is dismissing the company’s internal investigation findings. In other news on the crisis: Democrats are concerned lawmakers are moving too quickly on bipartisan opioid package; common pain relievers are found to be safer than opioids for controlling dental pain; the FDA concludes a painkiller that’s had a bad reputation for more than a decade is actually safer than previously thought; and more.

‘Rapid Autopsy’ Programs Seek Clues To Cancer Within Hours Of Death

After Keith Beck died of bile duct cancer last year, family members said more than 900 people showed up to pay respects to the popular athletic director at the University of Findlay in northwestern Ohio.

Many were former students who recalled acts of kindness during Beck’s nearly 30-year career: $20 given to a kid who was broke, textbooks bought for a student whose parents were going through bankruptcy, a spot cleared to sleep on Beck’s living room floor.

But few knew about Beck’s final gesture of generosity. The 59-year-old had agreed to a “rapid autopsy,” a procedure conducted within hours of his death on March 28, 2017, so that scientists could learn as much as possible from the cancer that killed him.

“He was 100 percent for it,” recalled his ex-wife, Nancy Beck, 63, who cared for Beck at the end of his life. “It wasn’t the easiest thing to do, but it was important.”

Beck donated his body to a rapid-autopsy research study at the Ohio State University, part of a small but growing effort by more than a dozen medical centers nationwide. The idea is to obtain tumor tissue immediately after death — before it has a chance to degrade. Scientists say such samples are the key to understanding the genetics of cancers that spread through the body, thwarting efforts to cure them.

“People are recognizing that cancer is more heterogeneous than we realize,” said Dr. Sameek Roychowdhury, a medical scientist at OSU’s Comprehensive Cancer Center. “Different parts of your body may have different cancer cells, even though they originated from the same cancer.”

In Beck’s case, results from the rapid autopsy showed he had developed a mutation that caused the experimental drug he was taking, known as an FGFR inhibitor, to stop working. Roychowdhury and colleagues plan to report on Beck’s case in an upcoming paper.

“This is helping us shape how we develop this new drug,” Roychowdhury said. “How can we make a better drug? Or can we make a better drug combination?”

Rapid-autopsy technology has been available for decades. Researchers at the University of Washington in Seattle have been using the technique to study prostate cancer since 1991. Scientists at the University of Nebraska Medical Center launched a now-robust program in 2000.

But only in recent years have more hospitals been launching and expanding programs, said Dr. Jody Hooper, director of the Legacy Gift Rapid Autopsy Program at Johns Hopkins Medicine in Baltimore. At last count, there were 14 similar programs in the U.S.

Funding for them varies, Hooper said, but typically they’re supported by a mix of cancer program resources, grants and researcher fees.

Scientists recognize the value of examining tissue from multiple sites soon after death and obtaining larger samples than they could while a patient was living. Cancer cells can be retrieved during such autopsies and kept alive, allowing researchers to experiment with ways to treat — or kill — them.

“It’s the power of sampling over the entire body at the same time,” said Hooper, who conducts about one rapid autopsy a month, often providing tissue for up to a half-dozen researchers interested in different questions.

Most programs focus on cancer, but efforts are underway to expand the practice, possibly to shed light on virus reservoirs in HIV patients, for instance.

Speed is essential to preserve RNA and DNA, the building blocks of cells, which can degrade quickly after death. It’s best to obtain specimens of living cells within six hours of death and other tissue within 12 hours, Hooper said.

The need for speed is also what makes such autopsies challenging. Families must consent to the procedure, often while freshly grieving their loved one’s death. And the logistics surrounding retrieving a body, conducting an autopsy and then returning the body for a funeral are often complicated. Traffic is unpredictable and “one time, there was a blizzard,” Hooper said.

Roychowdhury said he and one of his clinical fellows are on call at all times.

“The patients have our cellphone numbers, as well as the next of kin,” he said.

Broaching the subject with patients and families requires tact and compassion. Most patients are enrolled in clinical trials and learn about the autopsies from their doctors or pathologists like Hooper. Many are willing, even eager, to cooperate, she said.

“These are mostly patients with metastatic cancer,” she said. “They’ve made their peace with the outcome long before.”

For some, the rapid autopsy is simply the final phase of the clinical trial.

“They want to do something not only for themselves, but also to help others,” Roychowdhury said.

That’s how Linda Boyed, 52, of Lewis Center, Ohio, sees it. Like Beck, she has bile duct cancer and is enrolled in a trial to treat it. The drugs are working now, but Boyed said she has agreed to a rapid autopsy after death so scientists can learn from her when they’re no longer effective.

“I have a strong Christian faith,” she said. “I believe we’re put on this Earth to help each other.”

Because the rapid autopsies are paid through program funds and grants, there’s no cost to the families. Bodies are returned within a day and in a condition that doesn’t affect funeral plans.

“My emphasis is that it was all done with dignity and respect,” said Nancy Beck. “We felt honored to be able to do this.”

Performing the autopsy after treating a patient in life is an honor for doctors, too, Roychowdhury said.

“This was once a living, breathing person that came into my office every other week,” he said. “The thing I want to think about each day is that they’ve given so much so that others can benefit.

“Everyone has something to teach us after death.”

Hospitals Lure Diabetes Patients With Self-Care Courses, But Costs Can Weigh Heavily

When a routine physical revealed mildly elevated blood-sugar levels, Michael Phillips was strongly encouraged to sign up for a diabetes self-management class.

Phillips never asked about the cost of the two half-day sessions he attended in a conference room at St. Mary’s Hospital in Athens, Ga., and doesn’t recall the instructor mentioning it.

But the 64-year-old retired bank analyst was flabbergasted when he opened his bill after attending.

“What, $1,044 for a class?” said Phillips, who fought the bill with the hospital and his insurer, Blue Cross Blue Shield of Georgia. “The hospital is charging an exorbitant rate, but BCBS is going along with it — why aren’t they screaming about being gouged?”

There are about 1.5 million Americans newly diagnosed with Type 2 diabetes each year. Unlike Type 1 diabetes, an autoimmune disease in which people produce no insulin that begins in childhood, Type 2 diabetes is a condition of adulthood, typically associated with weight and a sedentary lifestyle.

Michael Phillips was flabbergasted when he got a bill for $1,044 for a diabetes self-management class that he took at St. Mary’s Hospital in Athens, Ga. He fought the bill with both the hospital and his insurer, Blue Cross Blue Shield of Georgia. (Credit: Patrick Hutchinson)

Diabetes self-management programs teach patients how to monitor their blood sugars, what to eat and the importance of exercise as strategies to delay or avoid the disease’s serious complications.

Patients like Phillips, with early or mild diabetes, can modify their habits so that their blood sugar returns to normal.

But the classes, targeting a disease that affects 30 million Americans, have also become a revenue generator for hospitals and an opportunity for marketing and branding.

“If you can get 25 in the class and charge $500 each, you can make a lot of money,” said Gerard Anderson, a professor of health policy and management Johns Hopkins University Bloomberg School Public Health. An additional incentive is that the classes bring “people into the hospital that they expect will need the hospital in the future.”

Phillips’ class had about a dozen students, who got a free lunch, free parking and a sample of Glucerna, a nutrition drink formulated for diabetics. The instructor noted that St. Mary’s operates a gym that participants could join for a fee.

Diabetes is among the costliest of medical conditions. The American Diabetes Association estimates that average medical expenditures for those diagnosed with diabetes are 2.3 times higher than those without.

The classes, say experts, are a chance to rein in some of that spending. When Harvard Law School researchers ran the numbers in 2015, they found an estimated savings of $1,309 over three years for every Medicare Advantage patient who completed an education program.

But for many patients, the cost of the classes can either become a barrier to actually attending, or leave them with unanticipated bills.

After St. Mary’s billed Phillips’ insurer $1,044 for the two half-day classes he attended, Blue Cross Blue Shield of Georgia, in turn, lowered that to $626, or the “allowed amount” it had negotiated with St. Mary’s. Because he had not yet met his $3,500 annual deductible, Phillips is responsible for the entire $626.

Phillips, who took early retirement from his job in 2005 to care for his elderly parents, said he likely would not have attended had he known the price. He’d expected the instruction to cost about $50, noting that he’d already paid $120 for a one-on-one session with one of the hospital’s certified diabetes educators or CDEs.

Medicare sets an average reimbursement of $356 for an entire nine-hour group course, with the beneficiary’s share of that amount estimated at $71.

St. Mary’s said it is proud of its fully accredited program, which helps diabetes patients manage their condition.

“Our charges are in line with other similarly recognized programs in the state,” according to a written statement from Mark Ralston, public relations director for the St. Mary’s Health Care System.

“Prior to enrollment, we send patients a letter that includes information that there will be a charge,” the statement said, noting that the amount “the patient will pay depends on the patient’s insurance coverage.”

Ralston also noted that, because St. Mary’s is a Catholic health care system, “we are always happy to work with patients who have financial difficulties, up to and including applications for charity care.”

Phillips’ charges seem high even though they were for a program that might actually save the insurer money over the long term, said William Custer, who studies health care markets as the director of the Center for Health Services Research at Georgia State University.

He questioned why the insurer didn’t drive a harder bargain.

“If the course has a benefit in terms of increasing health and reducing utilization, Blue Cross has an incentive to cover it and an incentive to negotiate,” said Custer.

Blue Cross is one of the state and the region’s major insurers, Custer said, so it should have negotiated a better price.

Colin Manning, a spokesman for the insurer said, “We do have questions about the amount charged for this class and we are reaching out to St. Mary’s Hospital to discuss reimbursement for this service.”

Diabetes management courses vary considerably in length and format, and even more so in price.

Internet searches and phone calls uncovered some cost examples, ranging from a $396, nine-hour course in Ohio to one in Wisconsin that lasted six hours and had a $420 price.

One of the most expensive — a 7½-hour diabetes self-management group course that included two-hour individual sessions with a dietitian and a diabetes educator — cost $1,700 in Washington state.

Howard County General Hospital in Maryland has decided to bypass insurance and charge patients $50 upfront for a six-hour course taught by a certified diabetes educator. That price was selected because in many cases it was less than what people with insurance would pay in copayments or deductibles under the former price, which was billed to insurers at a rate of about $1,000.

Before they made the switch about a year and a half ago, patients would often cancel after learning how much they would owe, said Mike Taylor, a clinical manager and diabetes educator who runs the hospitals program. “We would literally lose half the appointments we would schedule.”

The Maryland hospital also offers free classes by a lay instructor.

Meanwhile, thinking his original bill was in error, Phillips in late January appealed St. Mary’s $1,044 charge to his insurer. It was denied a month later as the insurer noted the bill was “coded correctly.” Hospitals can charge what they like for their services.

And after being contacted by the hospital billing office in early April to confirm he was aware of his bill’s “delinquent status,” he wrote a second appeal letter.

Phillips said the class was well-taught, though he noted that he was already dieting before he took the class. He “followed what they said” and he has lost 31 pounds. His blood sugar, he added, is also back in the normal range.

“At least now I’m well-informed about what to eat and not eat if I ever do have diabetes,” he said wryly.

Recycling Donated Organs? Doctor Breaks Taboo Of Re-Using Kidneys In Midst Of Shortage

Dr. Jeffrey Veale is the first surgeon focused on making the re-use of transplanted kidneys routine. “We shouldn’t be discarding these young, healthy kidneys,” he says. In other news, the United Network for Organ Sharing, which has held a tight rein on organ donation in the United States, may be facing competition.

Trump Defends VA Nominee But Gives Him Cover To Withdraw Amid Allegations Of Misconduct, Lax Prescription Practices

Dr. Ronny Jackson has been accused of overseeing a hostile work environment where staff had to “walk on eggshells” around him, drinking while on overseas trips and then banging on a female employee’s hotel door, and doling out prescription medications with such frequency as to earn the moniker “the candy man.”

Peak Health Plan Premiums Give Rise To Activism — And Unconventional Solutions

CHARLOTTESVILLE, Va. — When Garnett and Dave Mellen sent their 19-year-old daughter, Gita, off to college an hour away at Virginia Commonwealth University last fall, they didn’t expect to follow her.

But in November, the family received notice that its monthly health insurance premium in Charlottesville would triple for 2018, from $1,200 to an unaffordable $3,600.

So, the Mellens, both longtime local business owners, packed their bags and spent time with Gita in her off-campus apartment in Richmond.

“My whole life has been rearranged around trying to get health insurance,” Garnett Mellen, 56, said, as she explained that claiming residency with her daughter in the new ZIP code had cut their premiums by more than half.

Charlottesville now claims the dubious distinction of having the highest individual-market health insurance costs in the country — prompting families like the Mellens to look for extreme solutions.

An exodus of carriers, which was blamed on losses caused by the instability of the Obamacare marketplace, created a coverage vacuum, leaving locals and insurance regulators scrambling.

Only one carrier — Virginia Beach-based Optima Health — decided to continue to participate in the individual market, but it did so with monthly premium increases that were, on average, in the high double-digits and for some consumers as much as 300 percent, according to people interviewed for this story.

It’s a problem that’s likely to be replicated elsewhere, said Timothy Jost, an emeritus professor of law at Washington and Lee University in Virginia and expert on the health law.

“In many states, it’s going to be hard to maintain a functional individual market,” he said. “Charlottesville is sort of ahead of everybody else in this … but this is the direction things are heading.”

Insurers nationwide that intend to participate in the individual market face spring deadlines to file forms for 2019 plans and rate proposals. In Virginia, these dates are April 20 and May 4, respectively.

The situation in Charlottesville has left many residents at their wits’ end about how to pay for their health insurance, prompting the evolution of an angry and rebellious civic movement and thrusting the costs of coverage into the center of local politics.

Charlottesville for Reasonable Health Insurance, a grass-roots organization and Facebook group of more than 700 people, has already claimed small victories in the state legislature, such as propelling the passage of a bill that will alleviate the cost burden for some of its members.

But its highest priority has been pressing state regulators to explain and possibly reconsider the decision that allowed for the stunning premium increase.

In the midst of various bureaucratic fits and starts, the state Bureau of Insurance (BOI) responded to the group April 11 by reiterating that Optima’s rates were “actuarially justified.” Ian Dixon, one of the group’s organizers, said it plans to appeal this finding to the State Corporation Commission.

“We’re not going away, that’s for sure,” said Dixon. “They’re hoping they can wait us out. … They would drag this out for a year if they could.”

At the same time, the group has expanded its focus to other issues on health care costs, such as price transparency and regulatory reform.

When the Mellens found out their monthly health insurance premium in Charlottesville would triple for 2018, from $1,200 to an unaffordable $3,600, they packed their bags and spent time with Gita in her off-campus apartment in Richmond. (Julia Rendleman for KHN)

“My whole life has been rearranged around trying to get health insurance,” Garnett Mellen said. (Julia Rendleman for KHN)

How It Came To This

The trouble started in summer 2017, when the state’s major insurance carriers announced they would be leaving the individual market in Virginia, saying the market was “shrinking and deteriorating” — pointing to the instability of Obamacare under the Trump administration.

Their departures left Albemarle County, home to Charlottesville, bare — meaning residents had no insurance options.

When Optima opted to continue to offer plans in and around Charlottesville, state insurance regulators breathed a collective sigh of relief.

But Optima’s decision came with updated rate increase proposals, which gained the OK of the under-the-gun BOI, led by Commissioner Scott White.

“I think the [regulators] decided they were willing to accept almost anything to get someone to cover Albemarle County and Charlottesville,” Jost said.

About 15 miles north of Charlottesville on U.S. 29, there’s a billboard that some residents now view with bitter irony. It features a smiling man with the message: “I chose Optima.”

On one hand, Optima did fill a void and offer health plans where no other insurer would. Still, many residents found their only choice came with a 300 percent boost in premium costs. They felt that state regulators had fallen short of their consumer-protection responsibilities.

“Any assumption that I had … that I thought [the Bureau of Insurance would be] protecting the people … was completely naive,” said Sarah Stovall, 40, who works for a small software company, lives in Charlottesville with her husband and two sons and has struggled to find affordable coverage.

But Ken Schrad, the director of the Division of Information Resources for the State Corporation Commission, said the bureau is still questioning Optima, checking its math and evaluating its actuarial decisions.

He couldn’t answer specific questions about a matter he said is pending.

Schrad said the bureau reached out to carriers and worked with them last summer when it was clear that much of the commonwealth wouldn’t be covered.

“It wasn’t a question of what the premiums would be,” Schrad said. “It was whether there would be any coverage.

“[Filings] must be based on actuarially sound decisions, and that’s all the bureau can review. The market is the market.”

A Movement Is Born

Stovall, 40, teamed up with Dixon, 38, a web app developer, to manage the emerging Facebook group, which was originally set up as a support system for people in search of new insurance options in a short window of time. Soon, Karl Quist, 46, who had been actively calling the BOI to lodge complaints, joined the effort.

“The three of us did not know each other before November,” Dixon said. “We feel like we’re relatives now.”

Others quickly piled on, including the Mellens and Gail Williamson, 64, a part-time secretary at a private school who needed insurance for herself and her husband, who owns a business restoring antiques.

Like many of the people in the group, the Williamsons made too much money to qualify for federal subsidies, but too little to be able to afford the $3,725 monthly premium that Optima would have charged them.

Sharing their knowledge, many Charlottesville for Reasonable Health Insurance members have resorted to imperfect jury-rigged policies that do not come with many of the coverage guarantees that protect patients from unexpected costs under the Affordable Care Act.

Instead of paying $2,920 a month for Optima’s least generous family health plan, Quist is saving $2,300 a month by purchasing two non-ACA-compliant plans, one for sickness and one for accidents.

Williamson has settled on a “silly little” three-month policy for $1,400 per month, plus an extra $35 a month in supplemental accident insurance for her husband.

“If I won the lottery, the first thing I’d do before giving my kids any money would be to buy health insurance for everyone in that group,” Williamson said.

Washington and Lee’s Jost said he worries about the impact of such cobbled-together coverage.

He said having these plans could damage the ACA market further by skimming the healthier people away from the more comprehensive coverage, leaving behind those who are ill or have chronic conditions.

“It makes the situation worse because the only people who are going to pay premiums that high are people who are desperate,” Jost said.

For Charlottesville resident Garnett Mellen (right), finding a way to cut her steep health insurance premiums involved spending more time at daughter Gita’s off-campus college apartment in Richmond. (Julia Rendleman for KHN)

Forward Motion

Over the past months, the community-based effort has evolved beyond being an ad hoc information clearinghouse into a powerful organizing tool.

For instance, it has raised almost $20,000 to hire lawyer Jay Angoff, a former federal and state insurance official, to appeal to Optima and state regulators about the Charlottesville-area rates.

Dixon, Stovall and Quist also regularly pile into Stovall’s minivan, drive to Richmond and become lobbyists for their cause.

“The insurance companies pay people very good money to lobby for them on a regular basis,” Stovall said. “Meanwhile, I have to take off work, Ian [Dixon] has to leave his business for a day.”

“On some level, I have faith that if we keep pushing, I don’t know what the eventual outcome will be, but we’ll find some type of justice,” Dixon added.

Their greatest victory came with the passage of SB 672. This law redefined what a “small employer” is so that self-employed people can buy insurance in the small-group market.

The group sought this change because many people, including Dixon, found that the cost of adding an employee to a company of one allowed them to save money by obtaining insurance as a small group, though it still added significant overhead costs to these businesses.

Many in the group see this success as only a band-aid fix. Though it allows some people to obtain cheaper insurance, it doesn’t address the root of the problem: Optima’s rate increases.

For Garnett Mellen, though, the issue seems resolved, at least for now. She found a job with health benefits in Charlottesville, which enabled her and her husband to move back there.

It’s a big relief — both for her and for Gita, her college-aged daughter.

“She [was] not entirely happy with us being there,” Mellen said.

How Scientists Decide When A Vaccine’s Risks Outweigh The Number Of People It Will Help

While the debate is theoretical, scientists can weigh possible risks versus the lives they know the vaccine will save. But a recent example of a controversial drug is throwing the issue into the global spotlight in a very real way. In other public health news: clinical trials and ethics; decoding a baby’s DNA; home health care workers and infection rates; a new type of self-harm in teenagers; and more.

How Scientists Decide When A Vaccine’s Risks Outweigh The Number Of People It Will Help

While the debate is theoretical, scientists can weigh possible risks versus the lives they know the vaccine will save. But a recent example of a controversial drug is throwing the issue into the global spotlight in a very real way. In other public health news: clinical trials and ethics; decoding a baby’s DNA; home health care workers and infection rates; a new type of self-harm in teenagers; and more.

Hospitals That Have Always Been Hesitant To Go Global Starts Looking Beyond Their Home Turf

The investment required to globalize has been daunting to the hospital industry. But facing anemic growth and other troubles, some hospitals are looking abroad. Meanwhile, Anthem is being taken to court over its new policies that restrict outpatient imaging and emergency department reimbursement.

Hospitals That Have Always Been Hesitant To Go Global Start Looking Beyond Their Home Turf

The investment required to globalize has been daunting to the hospital industry. But facing anemic growth and other troubles, some hospitals are looking abroad. Meanwhile, Anthem is being taken to court over its new policies that restrict outpatient imaging and emergency department reimbursement.

Must-Reads Of The Week From Brianna Labuskes

Welcome back to the Friday Breeze, where I can offer you a break from the Comey memos with a quick look at what you need to know about this week’s health care news.

Some recent abortion laws and legislative proposals in the states seem so strict they’re almost begging for a court challenge. Activists who think the Supreme Court is one Donald Trump-appointed justice away from overturning Roe v. Wade want to have a legal challenge in the pipeline ready to go. Others in the movement would rather focus on incremental changes, which is getting on the nerves of the more aggressive activists. “They’re standing in the way,” Rep. Steve King (R-Iowa) says in Politico’s story. “I’ve said, ‘Please lead, or get out of the way.’”

• Politico: Abortion Foes Seize On Chance To Overturn Roe

Tying performance and costs is a bit of a Hot Strategy these days, as everyone talks about ways to bring down health care spending. But Italy, which has been trying this approach for more than a decade, serves as a cautionary tale that, at least for drug prices, the efforts don’t really move the needle. Mostly because there’s a wide range of opinions on what exactly “success” looks like.

And in a look ahead: President Donald Trump is planning a big speech on drug prices next week. But don’t get excited— no new policies are expected to be announced.

• The Wall Street Journal: Italy Serves Cautionary Lesson For New Trump Drug Plan

• Politico: Trump Plans First Major Speech On Drug Prices Next Week

There was a lot of movement on the opioid crisis again this week (nursing homes turning away patients who are recovering from addiction; Sen. Bernie Sanders (I-Vt.) wanting pharma execs to go to jail; and scientists working on a drug that could end addiction). But a deeper recurring theme was how ethics would play into combating the epidemic. What role does the industry that helped create the crisis play in fixing it? Does it matter that advocates who are lobbying for more spending are going to profit from that newly opened congressional wallet? It’s a tricky minefield to navigate.

• Stat: NIH Abruptly Changes Course On Industry Opioids Partnership After Ethics Flags Raised

• Politico: Patrick Kennedy Profits From Opioid-Addiction Firms

Dr. Ronny Jackson, Trump’s nominee for VA secretary, is eager to please, well-liked and ambitious, according to a telling background profile by The Washington Post. But notably absent from the heaping of bipartisan praise were endorsements on his ability to lead the sprawling, troubled agency.

• The Washington Post: ‘He Knows How To Read A Room Really, Really Well’: How White House Physician Ronny L. Jackson Became Trump’s Nominee To Lead VA

In the miscellaneous file for this week: There’s a disturbing pattern of leniency and forgiveness toward doctors who are accused of sexual assault, and not even the #MeToo movement seems to be changing it; livers like to be kept “warm and happy” instead of put on ice (which led to my favorite lede from the week about how livers are not beers that you pack in a cooler for your camping trip); nefarious profiteers are persuading women to get surgeries they might not need just because that makes them better plaintiffs; and what happens when the teaching hospitals that are supposed to train new doctors instead pass off their bad habits?

• The Associated Press: AP Investigation: #MeToo Has Little Impact On Medical World

• Stat: A ‘Breakthrough In Organ Preservation’ Raises Hopes For Transplants

• The New York Times: How Profiteers Lure Women Into Often-Unneeded Surgery

• Stat: Doctors May Learn Bad Habits At Teaching Hospitals With Safety Violations

And former first lady Barbara Bush’s decision to stop medical treatment and seek comfort care this week stirred a debate over the emotionally charged topic of end-of-life decisions.

Kaiser Health News: Barbara Bush’s End-Of-Life Decision Stirs Debate Over ‘Comfort Care

Have a great weekend, and maybe skip the salad? I know, such a hardship.

And let us know what you think of The Friday Breeze here.