Guidelines can be barriers to ‘right care,’ replication and patient safety, and RCAW antibiotic stewardship

October 8, 2015

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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One in five U.S. adults, nearly 50 million people, suffers from hearing loss. Modern digital hearing aids can significantly improve hearing and quality of life, and can even be wirelessly connected to the wearer’s smartphone. But unfortunately, explains Jane E. Brody in The New York Times, many people who need hearing aids do not have them. One of the most significant barriers to obtaining hearing aids is the cost; the price tag for new, properly fitted hearing aids for both ears can be more than $5,000. And the device is often not covered by private insurance, and is never covered by Medicare (except for children). Mark Hammel, MD, says of this lack of coverage: “It’s so preposterous. Knee replacements, shoulder replacements, organ transplants, which can cost tens of thousands of dollars, are covered, but not hearing aids. Are you kidding me?” Another barrier to accessing hearing aids can be clinical guidelines. Hearing test cutoffs may say that an individual doesn’t need a hearing aid, but functionally they do. While guidelines may prevent some patients from receiving necessary care, they can also be the impetus for overuse. George A. Sarosi, MD, writes of “The Tyranny of Guidelines” in The Annals of Internal Medicine, recounting the story of a relatively healthy elderly man who quickly became a victim of overtreatment.


Recent research has raised questions about the reliability of scientific findings and the importance of replication, notes Shirley S. Wang in The Wall Street Journal. She cites two examples: a reanalysis of Study 329 (an investigation of the safety and efficacy of an antidepressant) and an effort to replicate findings from 100 psychology studies. The reanalysis of Study 329 reports that the negligible benefits of paroxetine (Paxil) do not outweigh the significant risks in adolescents. The psychological science study found that results were reproducible in only 39 of the 100 classic studies the authors replicated. Authors of both analyses argue that their findings demonstrate the need for more transparency, and Harlan Krumholz, MD, of Yale-New Haven Hospital, calls the Study 329 reanalysis “one of the strongest cases I have seen for open science and data sharing.” Journals like Psychological Science are striving to reward transparency, for example, by acknowledging when authors of a paper share their data. But the 15-year gap between the original publication of Study 329, the $3 billion in damages paid by Paxil manufacturer to patients who were harmed, and the reanalysis underscores that much still needs to be done to protect patient safety.


Congratulations to the Pediatric Council of the RightCare Alliance for launching an online antibiotic stewardship pledge for pediatric healthcare providers, urging all pediatric healthcare providers to take extra time to prescribe antibiotics correctly and judiciously, and to discuss the dangers of overusing these drugs with colleagues and patient families—beginning during RightCare Action Week (RCAW), October 18-24. Last year in the United States, there were more than 11.4 million unnecessary prescriptions for antibiotics written for children.  In childhood, antibiotic use is associated with the development of such chronic diseases as asthma, allergies, diabetes and other conditions. Providers from around the nation have already signed the pledge, vowing to educate families about unnecessary antibiotics. Alan Schroeder, MD, of Santa Clara Valley Medical Center, and Shawn Ralston, MD, of Dartmouth-Hitchcock Medical Center, spearheaded the effort and have also provided a list of “5 Rights” as a way to facilitate discussions. Providers who treat children and teens are encouraged to sign the PLEDGE and to read the blog about the activity. The pledge is just one of the many activities planned for the week by the RightCare Alliance, its captains and councils. Stay tuned for additional RCAW updates. What are you doing for RCAW? Tell us at




  • During RightCare Action Week (Oct 18-24), people across the country will be holding RightCare Story Slams. A Story Slam is a storytelling event that gives providers and patients a space to share their stories with a broad audience in order to build community around the unique narratives that exist in healthcare. If you’re interested in joining or hosting a RightCare Story Slam, please e-mail Paul Williams,






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