Tagged Public Health

University Of Illinois At Chicago Acknowledged Failure To Catch Warnings Signs Over Child Psychiatrist Who Violated Research Protocols

According to new documents, the University of Illinois at Chicago Institutional Review Board, the committee responsible for protecting research subjects, improperly fast-tracked approval of Dr. Mani Pavuluri’s clinical trial, didn’t catch serious omissions from the consent forms parents had to sign and allowed children to enroll in the study even though they weren’t eligible. Still, UIC officials have continued to blame only Pavuluri, and have downplayed the institution’s role in the research.

University Of Illinois At Chicago Acknowledged Failure To Catch Warnings Signs Over Child Psychiatrist Who Violated Research Protocols

According to new documents, the University of Illinois at Chicago Institutional Review Board, the committee responsible for protecting research subjects, improperly fast-tracked approval of Dr. Mani Pavuluri’s clinical trial, didn’t catch serious omissions from the consent forms parents had to sign and allowed children to enroll in the study even though they weren’t eligible. Still, UIC officials have continued to blame only Pavuluri, and have downplayed the institution’s role in the research.

British Gallery Latest Institution To Give Sackler Family’s Charitable Arm The Cold Shoulder Over Role In Opioid Crisis

Britain’s National Portrait Gallery has announced it won’t proceed with a $1.3 million pledge from a charitable organization overseen by some members of the Sackler family, which founded Purdue Pharma. A recent court case has been shedding light on just how large a role the family played in the aggressive marketing of the painkillers.

British Gallery Latest Institution To Give Sackler Family’s Charitable Arm The Cold Shoulder Over Role In Opioid Crisis

Britain’s National Portrait Gallery has announced it won’t proceed with a $1.3 million pledge from a charitable organization overseen by some members of the Sackler family, which founded Purdue Pharma. A recent court case has been shedding light on just how large a role the family played in the aggressive marketing of the painkillers.

New Treatments Might Provide Hope To Patients With Rare Genetic Disease That Turns Tissue Into Bone

The genetic disease, fibrodysplasia ossificans, in which the body’s machinery for healing goes awry, growing immovable bone where it doesn’t belong, had been languishing as nothing more than a medical curiosity. But a community of patient advocates rallied, and now there are three medicines in human trials, the most advanced of which could win Food and Drug Administration approval next year. In other public health news: weight lifting, primate emotions, the “bliss point” in food, and psychic mediums.

New Treatments Might Provide Hope To Patients With Rare Genetic Disease That Turns Tissue Into Bone

The genetic disease, fibrodysplasia ossificans, in which the body’s machinery for healing goes awry, growing immovable bone where it doesn’t belong, had been languishing as nothing more than a medical curiosity. But a community of patient advocates rallied, and now there are three medicines in human trials, the most advanced of which could win Food and Drug Administration approval next year. In other public health news: weight lifting, primate emotions, the “bliss point” in food, and psychic mediums.

Does It Make Sense To Delay Children’s Vaccines?

When Elyse Imamura’s son was an infant, she and her husband, Robert, chose to spread out his vaccinations at a more gradual pace than the official schedule recommended.

“I was thinking, ‘OK, we’re going to do this,’” says Imamura, 39, of Torrance, Calif. “‘But we’re going to do it slower so your body gets acclimated and doesn’t face six different things all of a sudden.’”

Seven years later, Imamura says her son, Amaru, is a “very healthy,” active boy who loves to play sports.

But delaying vaccines is risky. Many pediatricians will tell you a more gradual approach to vaccinations is better than no vaccinations at all, but they offer some hard advice to parents who are considering it.

“Every day you are eligible to get a vaccine that you don’t get one, the chance of an invasive disease remains,” says Dr. Charles Golden, executive medical director of the Primary Care Network at Children’s Hospital of Orange County.

Recent outbreaks of measles, mumps and whooping cough have once again reignited a war of words over vaccinations.

The squabble is often painted as two-sided: in one camp, the medical establishment, backed by science, strongly promoting the vaccination of children against 14 childhood diseases by age 2. In the other, a small but vocal minority — the so-called anti-vaxxers — shunning the shots, believing the risks of vaccines outweigh the dangers of the diseases.

The notion that there are two opposing sides obscures a large middle ground occupied by up to one-quarter of parents, who believe in vaccinating their children but, like the Imamuras, choose to do so more gradually. They worry about the health impact of so many shots in so short a period, and in some cases they forgo certain vaccines entirely.

Alternative vaccine schedules have been around for years, promoted by a few doctors and touted by celebrities such as Jenny McCarthy. Donald Trump endorsed the idea during a 2015 Republican presidential debate.

The concept gained a large following more than a decade ago, when Robert W. Sears, an Orange County, Calif., pediatrician, published “The Vaccine Book,” in which he included two alternative schedules. Both delay vaccines, and one of them also allows parents to skip shots for measles, mumps and rubella (MMR), chickenpox, hepatitis A and polio.

Sears’ book became the vaccination bible for thousands of parents, who visited their pediatricians with it in tow. But his ideas have been widely rejected by the medical establishment and he was punished by the Medical Board of California last year after it accused him of improperly exempting a 2-year-old from all future vaccinations. He declined to be interviewed for this column.

Imamura, who describes herself as “definitely not an anti-vaxxer,” says she and her husband “followed Sears to a T.” They limited the number of vaccines for their son to no more than two per appointment, compared with up to six in the official schedule. And they skipped the shot for chickenpox.

She concedes, however: “If there’d been outbreaks like now, it would have affected my thinking about delaying vaccines.”

Elyse and Robert Imamura with their son, Amaru (Courtesy of Elyse Imamura)

The ideas promoted by Sears and others have contributed to parents’ worries that front-loading shots could overwhelm their babies’ immune systems or expose them to toxic levels of chemicals such as mercury, aluminum and formaldehyde.

But scientific evidence does not support that. Infectious-disease doctors and public health officials say everyday life presents far greater challenges to children’s immune systems.

“Touching another human being, crawling around the house, they are exposed to so many things all the time on a daily basis, so these vaccines don’t add much to that,” says Dr. Pia Pannaraj, a pediatric infectious-diseases specialist at Children’s Hospital Los Angeles.

The same is true of some of the metals and chemicals contained in vaccines, which vaccination skeptics blame for autism despite numerous studies finding no link — the most recent published earlier this month.

In the first six months of life, babies get far more aluminum from breast milk and infant formula than from vaccines, public health experts say.

“When you look at babies that have received aluminum-containing vaccines, you can’t even tell the level has gone up,” says Paul Offit, professor of pediatrics at Children’s Hospital of Philadelphia (CHOP) and director of the hospital’s Vaccine Education Center. The same is true of formaldehyde and mercury, he adds.

(Offit co-invented Merck’s RotaTeq vaccine for rotavirus, and CHOP sold the royalty rights to it for $182 million in 2008. CHOP declined to comment on what Offit’s share was.)

Parents who are concerned about mercury, aluminum or other vaccine ingredients should avoid information shared on social media, which can be misleading. Instead, check out the Vaccine Education Center on CHOP’s website at www.chop.edu by clicking on the “Departments” tab.

The Centers for Disease Control and Prevention also provides a detailed breakdown of the ingredients in every vaccine at http://www.cdc.gov/vaccines.

If your child has a condition you fear might be incompatible with vaccinations, discuss it with your pediatrician. The CDC gives very specific guidelines on who should not receive vaccines, including kids who have immune system deficiencies or are getting chemotherapy or taking certain medications.

If your children are not among them, vaccinate them. That will help prevent outbreaks, protecting those who, for medical reasons, have not received the shots.

When parents resist, Pannaraj says, she emphasizes that the potential harm from infections is far more severe than the risks of the vaccines. She notes, for example, that the risk of getting encephalitis from the measles is about 1,000 times greater than from the vaccine.

Still, side effects do occur. Most are mild, but severe cases — though rare — are not unheard of. To learn about the potential side effects of vaccines, look on the CDC website or discuss it with your pediatrician.

Emily Lawrence Mendoza, 35, says that after her second child, Elsie, got her first measles, mumps and rubella (MMR) shot at 12 months of age, she spiked a fever and developed a full body rash that looked like a mild version of the disease.

It took three visits to urgent care before a doctor acknowledged that Elsie, now almost 5, could have had a mild reaction to the vaccine. After that, Mendoza, of Orange, Calif., decided to adopt a more gradual vaccination schedule for her third child.

Yet Mendoza says Elsie’s adverse reaction made her realize the importance of vaccinations: “What if she’d been exposed to a full-blown case of the measles?”


This KHN story first published on California Healthline, a service of the California Health Care Foundation.

State Highlights: Baltimore Mayor Leaves Hospital Board After Profit-Making Concerns Raised; ‘Dehumanizing’ Medical Care At N.Y. Jail Haunts Physician

Media outlets report on news from Maryland, New York, Texas, Kansas, Connecticut, California, Florida, Wisconsin, Minnesota, Arizona, Oregon, Massachusetts, Rhode Island and Louisiana.

Schools Tap Students To Help Fight Vaping Epidemic So That Message Is Coming From A Friend Instead Of An Adult

“It’s more effective to have students themselves who live in those areas, who go to those schools, who are part of the community to share their voice, share their story and to share why it’s harmful,” said Sonia Gutierrez, a supervisor with the Santa Clara County Office of Education in California. In other news on children’s health: professional hair removal for pre-teens and fighting food allergies.

Contraception App Claims It’s 99 Percent Effective, But Questions About How To Even Test That Rate Remain Unanswered

The app gives users a window of about 11 to 13 days during which they should use a condom or another birth control method to prevent pregnancy. Although a new study shows that it can be effective if used correctly, that data assumes the people who don’t respond aren’t pregnant, which is an underlying obstacle to proving efficacy on apps like these. In other public health news: the microbiome, broken heart syndrome, depression treatments, pre-term births, fish oil, medical marijuana and heart health.

When Drug Costs Get Too High, Patients Are Skipping Doses Or Just Not Taking Medication

Experts are worried this behavior could be extremely dangerous for the patients. “We have lots of treatments where if you don’t take them exactly as prescribed, you might be doing more harm than good,” said Stacie Dusetzina, a health policy researcher at Vanderbilt University. Other ways patients are trying to control costs are by asking for cheaper drugs from doctors or seeking out alternative therapies. Meanwhile, Ohio’s attorney general is suing UnitedHealth’s OptumRx unit alleging it overcharged the state for prescription drugs.

New Ads Accuse Trump Of Wanting To ‘Slash Our Health Care To The Bone’ With Proposed Medicaid, Medicare Cuts

The ad is the latest example of Democratic attacks on the Trump administration’s budget proposal for fiscal year 2020. Democrats saw health care as a winning issue in the midterms, and are hoping to repeat that success in upcoming elections. Other Medicaid news comes out of Tennessee, Ohio, Georgia and Idaho.

Did Your Doctor ‘Ghost’ You? An Employment Contract May Be To Blame

When Don Cue developed a bladder infection last fall, he called his longtime urologist’s office for a urine culture and antibiotics. It was a familiar routine for the two-time prostate cancer survivor; infections were not uncommon since he began using a catheter that connects to his bladder through an incision in his abdomen.

When Cue called this time, a receptionist told him that his physician, Dr. Mark Kellerman, no longer worked at the Iowa Clinic in Des Moines, a large multi-specialty group. She refused to divulge where he’d gone.

“As a patient, ‘scared’ is too strong a word, but my feeling is, ‘What do I do now?’” said Cue, 58.

Flummoxed, he solved his immediate problem by taking leftover antibiotics he had in his medicine cabinet.

It was only later that he learned his doctor had been fired by the Iowa Clinic and planned to start a urology practice with clinic colleagues. And, under the terms of their contract with their former employer, the doctors were banned for a year from practicing within 35 miles of the clinic and from recruiting former patients to follow them.

Contracts with so-called restrictive covenants are now common in medicine, although some states limit their use. Noncompete clauses — common in many commercial sectors — aim to stop physicians or other health care professionals from taking patients with them if they move to a competing practice nearby or start their own. But what may be good for business is bad for patient care — and certainly disquieting for those whose doctors simply disappear.

One survey of nearly 2,000 primary care physicians in five states found that roughly 45 percent were bound by such clauses.

Continuity of care is important, doctors say, especially for patients with ongoing medical issues. Cutting off access to a doctor is different from disrupting someone’s relationship with a favorite hairstylist or money manager, they say.

“When doctors want to move from one practice to another, if they’ve got good therapeutic relationships with their patients, you’d think that public policy would want them to continue to treat these patients that trust them,” said Judy Conti, government affairs director at the National Employment Law Project.

Charlie Wittmack, a lawyer at Hartung Schroeder in Des Moines, is representing Kellerman and the two other urologists who were also fired in a lawsuit against the Iowa Clinic. The wrongful termination suit asks the court to declare the physicians’ restrictive covenant provisions unenforceable. Wittmack said the controversy there was “tragic” for patients. “These are people who have prostate cancer or are in extreme pain because of kidney stones or have blood in their urine.”

Ed Brown, the clinic’s CEO, said the noncompete agreements are not just about business but also help ensure that the Iowa Clinic can provide reliable services.

“Noncompetes are good for the patients because they help to provide stability within a practice and ensure continuity of care,” Brown said recently in an email. Further, he added, noncompetes protect physicians by ensuring that other physicians in the practice are committed to the same agreement and can’t abandon it without proper notice.

The urologists “believe they can make more money elsewhere, and they don’t want to be held to any contractual responsibilities,” he said.

Even when longtime patients go sleuthing to find their doctors’ new offices, they may not be accepted into those practices. Hospitals and clinics say they have little choice but to respect the terms of business agreements that others have negotiated.

UW Health, the health care system for the University of Wisconsin-Madison, recently hired three primary care doctors who had worked across town, said Dr. Sandra Kamnetz, vice chairwoman of clinical care for the Department of Family Medicine and Community Health at the University of Wisconsin’s School of Medicine and Public Health. They are taking great pains not to treat any of the new doctors’ former patients because the terms of the doctors’ contracts with their old employer prohibit them from taking care of former patients for two years.

Staff at the UW clinics ask prospective patients if they’ve ever been seen by one of the doctors. They then check the patient’s electronic health record to confirm there are no messages, prescription refills or other recent contact with the new UW Health doctors and that patient at the previous job, said Kamnetz.

When Don Cue called his longtime urologist in Des Moines to get an appointment, the receptionist said the doctor no longer practiced there and would not explain why or where he had gone.(Courtesy Don Cue)

“Patients get frustrated, but what they may not understand is that this is a legal thing that we have to abide by,” she said.

Whether noncompete clauses are binding in health care — especially when patient care is disrupted — is a point legal scholars debate. In general, to be enforceable, the agreements must be reasonable and narrowly drawn so that they protect an employer’s legitimate business interest but don’t unduly restrict a doctor’s ability to make a living.

Courts may weigh whether enforcing a noncompete clause would create a physician shortage in a particular region or specialty. The guiding principle is patient choice, said David J. Clark, a partner in the New York office of the law firm Epstein Becker Green who has analyzed state noncompete statutes in health care.

“No court is going to deny a patient who wants to go see a doctor of her choice,” Clark said.

Most disputes are settled before they make it to court, however.

A recent report by the Trump administration evaluating how to promote choice and competition in health care recommended that states examine noncompete agreements for their effect on patients’ access to care and the supply of providers.

Several states, including Massachusetts and Colorado, that allow noncompete clauses in employment contracts generally won’t enforce them against doctors, according to Clark’s analysis.

Other states, such as Texas and Tennessee, place limits on the agreements. In Texas, for example, a noncompete pact must allow doctors to have access to a list of their patients in the past year and access to their medical records, among other things, Clark found.

Medical board rules take it a step further. “In Texas, when a physician leaves, the practice is required to cooperate with a physician who wants to put up a notice that says this is where that physician can now be contacted,” said Kathy Poppitt, a partner in the health care and government and internal investigations practices at the Austin, Texas, office of King & Spalding.

The American Medical Association, which represents doctors, doesn’t oppose restrictive covenants outright, although its policy notes they can limit patients’ choices. “To the extent that these agreements disrupt continuity of care and disrupt patient choice, this is of great concern to the AMA,” said Dr. Patrice Harris, the organization’s president-elect.

For patients in central Iowa, the departures of longtime urologists at the Iowa Clinic is dizzying. After Kellerman and his colleagues left, five of the clinic’s remaining seven urologists submitted their resignations. They are also subject to noncompete restrictions. They left the practice in mid-February.

Brown, the clinic CEO, said the urology department has replaced four of the eight urologists and has nine nurse practitioners or physician assistants to treat patients. The clinic is continuing to recruit physicians and advanced practice providers like nurse practitioners.

Susan Murphy, 72, has seen a number of doctors in the urology department. Dr. Richard Glowacki, one of the urologists who left with Kellerman, performed surgery to remove her kidney stones more than a decade ago. Another, Dr. Stephanie Pothoven, did surgery to repair her prolapsed uterus a few years ago.

Murphy said she got a letter from Pothoven announcing her departure. It didn’t provide details about where she would be going.

“I’ve got it etched in my brain to find out where they went,” she said. She has no plans to return to the Iowa Clinic. “Somehow they lost sight of patient care and were more concerned about the bottom line,” she said.

Billionaire-Backed Health Venture ‘Haven’ May Find Itself Facing Legal Challenges Over Name

There are already dozens of companies named “Haven,” with a large handful that deliver or facilitate health services. “It seems very risky to me,” said Jonathan Bell, managing director of Want Branding, a firm that advises companies on name selection. In other health industry news: health savings accounts, hospitals’ religious policies, cost disclosures, and minimum wage increases.

Billionaire-Backed Health Venture ‘Haven’ May Find Itself Facing Legal Challenges Over Name

There are already dozens of companies named “Haven,” with a large handful that deliver or facilitate health services. “It seems very risky to me,” said Jonathan Bell, managing director of Want Branding, a firm that advises companies on name selection. In other health industry news: health savings accounts, hospitals’ religious policies, cost disclosures, and minimum wage increases.