Doctor contrasts his care with patients
Tue, 03 Apr 2007 11:22:58 GMT
By LINDSEY TANNER, AP Medical Writer
Dr. Perry Klaassen lived to tell about his frightening ordeal with colon cancer. His patient did not. Same age, same state, same disease. Striking similarities, Klaassen thought when Shirley Searcy came to his clinic in Oklahoma City. It was July 2002, a year after his own diagnosis. But there was one huge difference: Klaassen had health insurance, Searcy did not.
His treatment included surgery two days after diagnosis and costly new drugs. They have kept him alive six years later despite disease that has now spread to his lungs, liver and pelvis.
"I received the most efficient care possible. I was 61 years old and had good group health insurance through my workplace," he wrote in an essay in a medical journal essay that starkly contrasts his care with that of his uninsured patient.
A widowed mother of eight grown children, Searcy had little money. When she began to sense she might be sick, she put off going to the doctor for a year because she knew she couldn't pay the medical bills. Deeply religious, she put her faith in God, according to her family.
By the time she saw Klaassen, her cancer had spread from her colon to her liver. She had surgery but rejected chemotherapy.
"She just really didn't feel like she wanted to endure what that would cost physically or financially," said her daughter-in-law, Karen Searcy.
Shirley Searcy died Dec. 22, 2003, about 18 months after her diagnosis.
___
While recent attention has focused on high-profile cancer patients like Elizabeth Edwards and Tony Snow, who have the means and insurance to pay for the best treatment, there are tens of thousands of tragic, unseen cancer cases like Searcy's — people whose lack of insurance stops them from seeking care when they should.
An estimated 112,000 Americans with cancer have no health insurance, according to Physicians for a National Health Program.
And that's only cancer. Among the 45 million Americans who have no health insurance, there are countless people with chronic and developing health problems who are risking the same kind of fate that took Searcy's life.
Klaassen's essay in the
http://jama.ama-assn.org
Man with drugresistant TB locked up
Tue, 03 Apr 2007 03:00:59 GMT
By CHRIS KAHN, Associated Press Writer
PHOENIX - Behind the county hospital's tall cinderblock walls, a 27-year-old tuberculosis patient sits in a jail cell equipped with a ventilation system that keeps germs from escaping. Robert Daniels has been locked up indefinitely, perhaps for the rest of his life, since last July. But he has not been charged with a crime. Instead, he suffers from an extensively drug-resistant strain of tuberculosis, or XDR-TB. It is considered virtually untreatable.
County health authorities obtained a court order to lock him up as a danger to the public because he failed to take precautions to avoid infecting others. Specifically, he said he did not heed doctors' instructions to wear a mask in public.
"I'm being treated worse than an inmate," Daniels said in a telephone interview with The Associated Press last month. "I'm all alone. Four walls. Even the door to my room has been locked. I haven't seen my reflection in months."
Though Daniels' confinement is extremely rare, health experts say it is a situation that U.S. public health officials may have to confront more and more because of the spread of drug-resistant TB and the emergence of diseases such as
SARS and avian flu in this increasingly interconnected world.
"Even though the rate of TB in the U.S. is at the lowest ever this last year, we live in a globalized world where, if anything emerges anywhere, it could come to our country right away," said Mark Harrington, executive director of the Treatment Action Group, an American advocacy group.
The
World Health Organization warned last year of the emergence of extensively drug-resistant TB. The new strain, which has been found throughout the world, including pockets of the former Soviet Union and Asia, is resistant not only to the first line of TB drugs but to some second-line antibiotics as well.
HIV patients with weakened immune systems are especially susceptible. In South Africa, WHO reported that 52 of 53 HIV patients died within an average of 25 days after it was discovered they also had XDR-TB.
How to deal with people infected with the new strain is a matter of debate.
Dr. Ross Upshur, director of the Joint Centre for Bioethics at the University of Toronto, said authorities should detain people with drug-resistant tuberculosis if they are uncooperative.
"We're on the verge of taking what was a curable disease, one of the best known diseases in human endeavors, and making it incurable," Upshur said.
But a paper Upshur co-wrote on the issue in a medical journal earlier this year has been strongly criticized.
"Involuntary detention should really be your last resort," Harrington said. "There's a danger that we'll end up blaming the victim."
In the United States, which had a total of 13,767 reported cases of tuberculosis in 2006, public health authorities only rarely have put TB patients under lock and key.
Texas has placed 17 tuberculosis patients into an involuntary quarantine facility this year in San Antonio. Public health authorities in California said they have no TB patients in custody this year, though four were detained there last year.
Upshur's paper noted that New York City forced TB patients into detention following an outbreak in the 1990s, and saw a significant dip in cases.
In the Phoenix area, only one other person has been detained in the past year, said Dr. Robert England, Maricopa County's tuberculosis control officer.
Daniels has been living alone in a four-bed cell in Ward 41, a section of the hospital reserved for sick criminals. He said sheriff's deputies will not let him take a shower — he cleans himself with wet wipes — and have taken away his television, radio, personal phone and computer. His only visitors are masked medical staff members who come in to give him his medication.
The ventilation system draws out the air and filters it to capture the bacteria-laden droplets he expels when he coughs. The filters are periodically burned.
Daniels said he is taking medication and feeling a lot better. His lawyer would not discuss his prognosis. Daniels plans to ask for his release at a court hearing late this month.
Daniels lived in Russia for 15 years and returned to the United States last year after he was diagnosed. He said he thought he would get better treatment here, and hoped eventually to bring his wife and children from Russia. He said he briefly worked in an office in Arizona for a chemical company before he was put away.
He said that he lost 50 pounds and was constantly coughing and that authorities locked him up after they discovered he had walked into a convenience store without a mask.
"Where I come from, the doctors don't wear masks," he said. "Plus, I was 26 years old, you know. Nobody told me how TB works and stuff."
County health officials and Daniels' lawyer, Robert Blecher, would not discuss details of the case. But in general, England said the county would not force someone into quarantine unless the patient could not or would not follow doctor's orders.
"It's very uncommon that someone would both not want to take treatment and will willingly put others at risk," England said. "It's only those very uncommon incidents where we have to use legal authority through the courts to isolate somebody."
University of Pennsylvania medical ethicist Art Caplan said Maricopa County health officials were confronted with the same ethical dilemma that communities wrestled with generations ago when dealing with leprosy and smallpox.
"Drug-resistant TB, or drug-resistant staph infections, or pandemic flu will raise these questions again," Caplan said. "We may find ourselves dipping into our history to answer them."
Daniels said he realizes now that he endangered the public. But "I thought I'd come to a country where I'd finally be treated like a person, and bam, here I am."
Ark. company develops food safety test
Tue, 03 Apr 2007 03:00:36 GMT
LITTLE ROCK, Ark. - An Arkansas company has developed a new, fast method to test food for pathogens such as
E. coli and salmonella that are the most common causes of food-borne illnesses. The process developed by Little Rock-based Litmus LLC can provide results in about 15 minutes instead of the standard two or three days, according to an executive of the company.
The company worked with the USDA's National Center for Toxicological Research at White Hall for two years to develop the Rapid-B test for growers, producers and processors to test food for the bacteria that could cause food-related illnesses.
Ted Moskal, president of Litmus-Rapid-B, a subsidiary of Litmus and the commercial partner for the NCTR, said the standard testing methods for food-borne pathogens are a two-step process. A culture is grown from the food sample and then sent to a laboratory where it is assessed by experts.
"About 48 hours later the results are sent back, and that does not include the time it takes for transportation of the samples," Moskal said. That time frame can be a significant delay for perishable products like meats and fresh produce.
Rapid-B, however, bypasses the standard culture-growing processes and can identify individual bacteria in about 15 minutes.
Moskal said the products are swabbed with a collection tool, then mixed with agents that reveal the types of pathogens present. The instruments involved do not require a laboratory environment, he said.
"We count the individual bacteria," Moskal said. "It's very specific. The biggest thing is that we have no false positives and no false negatives."
The Centers for Disease Control and Prevention estimates that unsafe foods cause as many as 76 million illnesses in the U.S. annually. Most recently, an E. coli outbreak in spinach killed three people and sickened more than 200, while a salmonella outbreak linked to certain jars of peanut butter caused nearly 300 people to fall ill.
Litmus chief executive Mark Diggs said the new tests will help protect the public from future outbreaks of food-borne pathogens.
"One of the key issues in protecting the public from bacterial outbreaks is being able to quickly and accurately detect bacterial pathogens before they hit the grocery shelves," he said.
NCTR officials referred calls to Moskal.
Woman sues hospital after infection
Tue, 03 Apr 2007 02:13:11 GMT
SANFORD, Fla. - A woman who contracted flesh-eating bacteria and had to have all her limbs amputated sued a hospital Monday for medical malpractice.
Claudia Mejia's lawsuit against South Seminole Hospital, filed in state circuit court, seeks unspecified damages, the Orlando Sentinel reported. It claims the hospital failed to detect early signs of an infection after she gave birth to a boy in April 2005.
Mejia developed a form of streptococcus that resisted conventional treatment, according to medical records. She went into shock, gangrene set in, her kidneys began to fail and doctors amputated her limbs to save her life.
The lawsuit names the hospital; its parent company, Orlando Regional Healthcare System Inc.; two doctors; a nurse; and two midwives.
An attorney for Orlando Regional, Jennings Hurt, issued a statement Monday saying the company determined Mejia did not get the infection at the hospital.
"The investigation also revealed that the care provided by its nurses was appropriate and reasonable," the statement said.
Overweight people more likely to get asthma
Mon, 02 Apr 2007 19:02:57 GMT
By Julie Steenhuysen
CHICAGO - Obese and overweight people are 50
percent more likely to get asthma than those of normal weight,
suggesting that weight loss could help reduce the number of
asthma cases, U.S. researchers said on Monday.
Asthma, an inflammatory disease usually triggered by an
allergy, can cause wheezing, coughing and labored breathing
that can be life-threatening. It affects about 7 percent of the
U.S. adult population. Obesity and being overweight are far
more prevalent, affecting about 65 percent of U.S. adults.
Both types of ailments are on the rise and a new study
suggests the two may be linked.
&;Overweight and obesity significantly increases the risk of
developing asthma,&; said Dr. E. Rand Sutherland of the National
Jewish Medical and Research Center in Denver, Colorado, who
wrote the study.
&;If you can substantially reduce the amount of overweight
or obese people, you might also get a reduction in the number
of new cases of asthma,&; Sutherland said in a telephone
interview.
Sutherland and colleagues, writing in the April issue of
the American Journal of Respiratory and Critical Care Medicine,
said a significant reduction in the incidence of overweight or
obese people could cut the number of new asthma cases in the
United States by 250,000 per year.
In children, where the incidence of asthma is five times
higher than in adults, the researchers suggested that even
small weight reductions could have a big impact in reducing the
number of new asthma diagnoses.
Sutherland said the study gives another reason to develop
effective treatments for excess weight, which can cause
diabetes, high blood pressure and certain cancers.
The researchers looked at seven studies on severe asthma
involving 333,102 patients.
People in the studies either had a doctor's diagnosis of
asthma or were taking asthma medication.
They were considered normal weight if their body mass index
-- a measure of weight in kilograms divided by height in meters
-- was below 25. People with a BMI measurement of 25 to 29.9
were considered overweight and people with a BMI of 30 or above
were considered obese.
The researchers said that obesity has been known to cause
impairments in lung function, even among people who do not have
asthma. As a result, some of the overweight and obese patients
who said they had asthma may instead have been suffering from
reduced lung volume and chest wall restriction associated with
their weight, Sutherland said.