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Reassessing solitary confinement, OxyContin exposed, and rushed, flawed tech news

May 12, 2016

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

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Features:

The number of individuals in solitary confinement in American prisons is staggering—about 80,000-100,000 at any time, according to last week’s The Guardian. Florida is one of the most egregious users of the practice, with one in eight prisoners in that state living in solitary confinement, and one in five prisoners with mental illness confined there. Last year President Obama asked the Justice Department to review the overuse of solitary confinement across the U.S. prison system, calling it “an affront to our common humanity.” Research suggests that solitary confinement can lead to lasting psychological consequences, including at times worsening existing mental illnesses or triggering new ones, he wrote in a Washington Post op-ed. That’s why he adopted the recommendations he requested from the Justice Department, among them a ban on solitary confinement for juveniles and as a response to low-level infractions. This week, in The New England Journal of Medicine, Cyrus Ahalt, MPP and Brie Williams, MD, support the president and call on health professionals to speak up. Labeling the prison system that houses 1.5 million Americans, “large health care settings for historically underserved patient populations,” the authors insist “that health professions have a responsibility to work with criminal justice policymakers to assess the risk of health-related harm underlying correctional practices such as solitary confinement.” They offered, as a good example, Norway’s penal system based on the principle that “people in prisons—like hospitalized patients—require targeted treatment delivered with compassion and humanity.”

OxyContin is one of America’s bestselling painkillers, with doctors writing 5.4 million prescriptions for it in 2014. It is also one of the best known drugs fueling the nation’s opioid epidemic. A Los Angeles Times investigation this week describes how the drug’s manufacturer, Purdue Pharma, launched OxyContin, touting its supposed painkiller distinctiveness—one dose relieves pain for 12 hours. But Purdue knew years earlier that the drug would wear off long before the 12 hours; independent research, complaints from physicians, and reports from their own sales reps told them so. Some patients began taking more than the prescribed dose to alleviate symptoms that recurred, fueling overuse. Yet Purdue clung to its 12-hour claim and instead recommended that physicians prescribe stronger doses for the drug for affected patients. Stronger doses increase the possibility of overdose and death; The Times found that more than half of the long-term OxyContin users are “on doses that public health officials consider dangerously high.” Financial bonuses and Hawaiian junkets were rewards for the sales reps pushing the higher dose 80-milligram OxyContin at $630 a bottle vs. the $97 for the 10-milligram. As OxyContin’s use grew, so too did scientific studies contradicting Purdue’s claims for the drug. One study showed that 2 percent of chronic pain patients who took OxyContin said the drug lasted 12 hours, and 85 percent said it wore off before eight. With such confusion, some physicians simply stopped prescribing the drug. “What I had come to see was the lack of evidence that it was any better than morphine,” said Mitchell Katz, MD, director of Los Angeles County’s unified health agency, in the article.

She was widely called “the next Steve Jobs,” for the technology she claimed to have developed, but Elizabeth Holmes wasn’t living up to the hype that her simplified blood-testing company, Theranos, would revolutionize the field. An article in Vanity Fair this month demonstrates how the tech media, in particular, failed to poke holes in the Theranos narrative, failed to see that the technology was faulty, that Theranos used other companies machinery to run some of its tests, and that results were often inaccurate. Why were nearly all news accounts about Theranos gushing with praise and amazement? A technology that clearly affects patient safety should have been vetted. Author Nick Bolton explains. “The system has been molded to effectively prevent reporters from asking tough questions…Outlets that write negatively about gadgets often don’t get pre-release versions of the next gadget. Writers who ask probing questions may not get to interview the CEO next time…” Theranos is facing tough times; it is under investigation by the SEC and US Attorney’s Office, and CMS has found deficiencies in the California lab. The Theranos saga underscores just how flawed disseminated information about new technologies, devices, drugs and other “break-throughs” can be, and the need for impartial bodies and impartial researchers to delineate fact from fallacy.

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Headlines:

Overuse

 

Medical errors

 

Med ed

 

Transparency

 

Payment models

 

Women’s health

 

Pharma

 

Social determinants

 

End-of-life care

 

Aging

 

Practice

 

Guns

 

RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.

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