Getting Less for More

There’s an excellent piece in this week’s New Yorker, by the surgeon-author Atul Gawande….must reading during the ongoing debate about healthcare reform. Gawande uses real life examples from a Texas community to illustrate just how broken our healthcare system is. The larger points of the article aren't exactly new, but the way he addresses them makes them very accessible. Go read it for yourself.

PPIs: The Dark Side

Two new studies add two more infections to the list of those that are associated with the use of proton pump inhibitors (PPIs). Previous papers have shown that ventilator-associated pneumonia, community-acquired pneumnonia, and Clostridium difficile associated disease are associated with PPI use. The large cohort study in today's JAMA found that PPIs were associated with a significant increase in the rate of hospital-acquired pneumonia in non-ICU, non-ventilated patients. And this month's American Journal of Gastroenterology contains a study showing that PPIs are associated with a higher rate of spontaneous bacterial peritonitis in patients with cirrhosis. Given the mounting evidence of risk for infection, coupled with the high frequency of use in hospitalized patients (the JAMA paper found that 52% of inpatients were prescribed PPIs), hospitals should probably begin to restrict the use of these agents.

Another reason to be a vegetarian

I just finished reading The Face on Your Plate, a book by Jeffrey Masson that explores the impact of eating meat on the environment, the cruelty the animals endure, and the denial that humans continue to exhibit with regard to all of this. He notes that the intense animal production by huge agribusiness is linked to zoonotic diseases, including new strains of influenza. The specific link to H1N1 influenza is outlined in an interesting article in The Guardian last month by Mike Davis. Although H1N1 has received a huge amount of media attention, this aspect of the story has seen little coverage.

What would Freud think?

In earlier postings here and here, I've discussed the incongruent nature of the actual risks of adverse events and the perception of those risks widely held by the public--more fear of plane crashes than automobile accidents, more fear of pandemic flu than seasonal flu, etc. This is the subject of a new book, Panicology, by two statisticians, Hugh Aldersey-Williams and Simon Briscoe. Of note, the book includes a section on hospital acquired infections. The authors postulate that the fear of HAIs and interest in the topic by the public may actually be the manifestation of a deeper fear, the fear of hospitalization itself. This is an interesting theory. Despite working in infection control for nearly two decades, I had never thought of that possibility.

How about a flu-free vacation?

According to today's New York Times, it's a great time to travel to Mexico. Discounts and upgrades at Mexican resorts are impressive. There are even flu-free guarantees. One resort chain is offering to pay the medical bills and give a free future vacation to anyone who develops influenza within 7 days of staying at its resorts. Another is offering three free future vacations to those who get infected.

When infection control and religion collide

The BBC News reports today that a healthcare worker in the UK is facing disciplinary action because she wears a cross around her neck on a chain, which is reported to impose an infection control risk. This is not the first time that infection control and religion have crossed paths in the UK. Last year a female Muslim healthcare worker was fired becaused her faith does not allow women to show their arms in public and her long sleeves violated the hospital's bare below the elbow policy. While the UK's serious attitude about infection control is noteworthy, the actions beg the question as to whether some reasonable accomodations could be made for observant workers (e.g., plastic isolation gowns for patient contact, ensuring that necklace chains are short to prevent jewelry from coming into contact with patients). If the UK's National Health Service continues its strident approach, then infection control will have become a religion unto itself.

WHO rewrites the rules

We’ve blogged about this before, but it now appears that WHO will soon be incorporating disease severity and potential harm into their global alert system.  From today’s NY Times article:

Dr. Keiji Fukuda, the deputy director general making the W.H.O. announcement, said that he could not predict exactly what the new rules would be but that criteria would include a “substantial risk of harm to people,” not just the geographic spread of a relatively benign virus.