Ebola and the CDC, limiting Partners’ consolidation, and when expensive care leaves patients “healthy, but harmed”: RightCare Weekly

October 23, 2014

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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  • Lown Institute Vice President Shannon Brownlee writes in Politico this week that the CDC made grievous errors in its early response to the Ebola crisis in West Africa and in its policies for dealing with cases in the US. But rather than being a reason to distrust the agency, those failures are an indication that the CDC needs more support from the public and from elected officials in their work to prevent a wide variety of public health crises – including issues like heart disease and obesity, not just short-term crises like Ebola. The CDC’s ability to respond to Ebola has been hampered by the contradictory belief that the government ought to have no role in promoting healthy behaviors to reduce chronic disease. But at the same time, it somehow should be able to stop an outbreak of infectious disease in its tracks. Public health infrastructure doesn’t work that way, and degrading our capacity to do one harms our ability to do the other.


  • David Dowdy, MD, PhD, wrote in a recent issue of JAMA about his experience treating a patient he believed was uninsured and was possibly facing a costly workup for tuberculosis. His story explores the ethical, cultural, and clinical difficulties of deciding how much to weigh the financial effects of medical care against the small chance that the patient might have a serious illness. Dowdy cared deeply about this patient, and wanted to protect him from spending time and money unnecessarily. At the same time, he worried about denying needed care and exposing his patient and his family to financial harm. The piece is short, but it presents a deep and important example of seeing patients’ financial burdens as another form of harm from overuse.


  • In a Boston Globe op-ed, Lown Institute Advisory Council member Donald Berwick, MD, cautions against the Partners hospital chain’s proposed acquisition of two additional hospitals in Massachusetts, until it proves it can contain costs. Partners’ prices are around 30 percent higher than the state average, and while it agrees, as part of a deal worked out with the state attorney general, not to raise prices over a six-year period at a rate higher than general inflation, data indicate that the acquisitions will lead to higher prices and raise total costs to individuals and businesses in the state. Moreover, there is no evidence that Partners hospitals offer better care than average. Berwick believes that the system, home to giants Massachusetts General and Brigham and Women’s, is commandeering opportunities for public investment and job growth in the state, as businesses face mounting healthcare costs that continue to limit growth.



  • Road to RightCare: Early bird registration has been extended through November. Register soon to save $150 on a remarkable conference! The conference will take place in San Diego, March 8 – 11, 2015. Also, don’t forget about our scholarships for students, clinical trainees, nurses, community leaders, and patient advocates! Applications are due December 7.



Big data and medical evidence:

  1. Ten impressions of big data: Claims, aspirations, hardly any causal inference – Austin Frakt, The Incidental Economist
  2. Why Doctors Need Stories – Peter D. Kramer, New York Times’ Opinionator
  3. Creating The Data-Inhaling Health Clinic Of The Future – David Shaywitz, Forbes


Medical culture

  1. Intolerance of error and culture of blame drive medical excess – Jerome Hoffman and Hemal Kanzaria, BMJ
  2. Doctors Tell All—and It’s Bad – Meghan O’Rourke, The Atlantic
  3. Healthcare Triage: Doctors, Money, and Conflicts of Interest – Aaron Carroll, The Incidental Economist


Healthcare delivery system

  1. Did CDC Laxity on One Infection Help Spread Another? – Michael Millenson, Forbes
  2. On an Antibiotic? You May Be Getting Only a False Sense of Security – Aaron Carroll, The Upshot



  1. Yes, Ebola Is Scary. But the System Is Working. – Harold Pollack, Politico
  2. Ethicist Calls CPR Too Risky in Ebola – Lawrence K. Altman, New York Times
  3. Ebola by the numbers – Rebecca Shabad, The Hill


End-of-life care

  1. Let Brittany Maynard’s story spark a dialogue about the end of your life – Ellen Goodman, Washington Post op-ed
  2. A Doctor Discovers Dying – Paula Span, New York Times’ New Old Age blog
  3. A Prescription for Life’s Final Stretch – Janet Maslin, New York Times


Pharmaceutical industry

  1. CVS has a plan to strong-arm other pharmacies out of selling cigarettes – Sarah Kliff, Vox
  2. Small group of specialty drugs could make up half of total pharmacy spending by 2018 – Ruth Tam, PBS Newshour



  1. Unable to Meet the Deductible or the Doctor – Abby Goodnough and Robert Pear, New York Times
  2. Even With Insurance, Language Barriers Could Undermine Asian Americans’ Access To Care – Shefali Luthra, Kaiser Health News


Patient safety

  1. Mission Hospital halts elective surgeries after patient infections – Angel Jennings, LA Times
  2. Sloppy Splinting Can Make A Child’s Broken Arm Much Worse – Deborah Franklin, NPR Shots blog


Over-testing and overdiagnosis

  1. Unneeded stress tests cost U.S. $500 million annually, study finds – Susan Perry, MinnPost
  2. Ovarian cancer fears prompt unnecessary surgeries, study finds – Victoria Colliver, San Francisco Chronicle


Defensive medicine

  1. The flawed concept of ‘defensive medicine’ – Don McCanne, MD, Healthcare Finance News


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