Opioid lawsuit: We’ve seen this before, and it didn’t go well.

When you live in Tobacco Road region of North Carolina, the local news tends to focus on 3 things; Duke basketball, UNC basketball, and Duke vs.UNC basketball. So it was a little surprising to see in the front page of my local paper that my own county is joining a lawsuit against three of the nation’s largest opioid distributors.

Perhaps I shouldn’t have been surprised, given the scope of the opioid epidemic. Opioid related deaths have topped 40,000 in recent years. The drug overdose death rate in in my home state of North Carolina jumped by nearly 24.7% from 2015 to 2016 and area hospitals including my own ICU can certainly attest to this.

Multiple state and county governments are joining lawsuits against opioid manufacturers and distributors to recoup costs which they allege were due to the crisis the companies helped create. And in a bit of sweet, sweet irony, even JCAHO (aka Joint Commission) a not-for profit entity responsible for antagonizing accrediting health care organizations is getting sued. I can tell you that no doctor will shed a tear over that one.

If all of this hullabaloo is giving you a sense of deja vu, I can’t blame you. We’ve done this before. 2018 marks the 20 year anniversary of the historic settlement between states and tobacco companies. Now that it’s clear that history is trying to repeat itself, it’s worthwhile to see what happened the last time we did this; are there lessons that we take away from the last 20 years?

While opioids have caused widespread harm, tobacco use dwarfs it. Tobacco abuse kills TEN TIMES as many people, an estimated 480,000 Americans every year, according to the CDC. To that end, several states attorneys general sued tobacco companies for costs incurred by smoking to their respective medicaid budgets in the  1990’s. The historic tobacco settlement was a huge victory. $206 billion was to be paid to the states over a span 25 years.  This money, the government said, was to be used to cover costs for tobacco related illness borne by state Medicaid programs and to pay for tobacco cessation programs.

However there was no mechanism in these agreements to ensure that the money was to be used for these purposes, only a pledge by politicians that they would do so. 20 years after the Master Settlement Agreement and we find that little of the money is being spent as intended. The American Lung Association reports that only 2% of the settlement money is being spent on smoking cessation programs. Amazingly, some states have used the money for tobacco production. But of these states, none is as egregious as my own home state of North Carolina. Here’s what an ALA post said:

“North Carolina used 75 percent of its settlement funds for tobacco production. Some of those North Carolina funds went to private tobacco producers, covering tobacco-curing equipment, a tobacco auction hall, video production for a tobacco museum and plumbing for a tobacco processing plant.”

Here in Orange county, a lawyer from a firm specializing in nursing home lawsuits, McHugh Fuller, gave a presentation to the Orange County Board of Commissioners to join 200 other governments nationwide in a suit against opioid  producers and distributors.  Despite having a relatively lower rate of opioid overdoses than other counties, the Board voted to join the suit. And why wouldn’t they?  It’s free money with little to no risk! Presentations like this are likely happening in city halls all over the country. Lawyers and government officials are seeing the potential for big pay-offs and increased revenues. Heck, they’re even bringing back  the same lawyers from the tobacco lawsuit.

Perhaps more important than who is in these meetings though, is who’s not in them. Health care providers, patients, their families, first responders. These lawsuits are entirely punitive, with no discussion on how the potential awards are to be used to help victims and their families. 

Meanwhile the tobacco settlement money continues to be wasted, even as tobacco continues to  kill more people than opiods by far. There remains little discussion about how to use this money better, or even whether it could be used to help victims of the opioid epidemic.

Clearly both healthcare and patient advocates need to take up a greater leadership role as these lawsuits go forward. There needs to be strong mandates so that the money from these settlements goes to the people it’s supposed to help and not wasted on building some  museum commemorating the history of vicodin.  As long we leave things up to lawyers and politicians we can expect no improvement in the lives of the people these suits are supposed to help.

Deep Ramachandran, M.D. is a Pulmonary, Critical Care, Sleep Medicine physician, and CHEST Journal Social Media Editor. He blogs at Caduceusblog and the CHEST Thought Leaders Blog. He is on twitter @Caduceusblogger.

Doctors’ Prescription to Reduce Gun Violence

Image result for sandy hook elementary school memorial

Like a lot of people, I get pretty numbed to gun violence on television. I stopped watching the local news because all they seem to show is news about shootings. The general public’s perception about gun violence is that it’s always somebody else, that the person  who was shot had somehow been involved in crime. The numbness we feel to gun violence often ends for most of us when things hit close to home, when you or someone you know is affected. Continue reading “Doctors’ Prescription to Reduce Gun Violence”

The Shocking Truth Behind “Shocking” Healthcare Social Media Statistics

As a regular follower of social media, I am keenly aware of changes in the healthcare landscape as it relates to social media. While there’s much talk about the impact of social media in healthcare, most of the action sits on the consumer side of the equation. Much of the medical world has to yet to tap into its potential. For most healthcare providers social media engagement amounts to little more than watching as others dip their feet, testing  the waters. A few watch as they anticipate their own entry into the arena. Still many others watch with the expectation that the water would soon become bloody.

So its with a burlap full  of salt that I read various healthcare social media stats promulgated in various infographics, twitter feeds, and blog posts celebrating Medicine 2.0 powered by social media. Collectively they hash and rehash a series of surprising statistics that aren’t exactly bogus, but aren’t exactly completely factual either.

A recent one caught my eye with the claim was that “53% of physicians practices have a facebook page”. This was curious to me, because as I read this in the physician lounge and  took my own poll, the results was much closer to 5% than 50%. Continue reading “The Shocking Truth Behind “Shocking” Healthcare Social Media Statistics”

Me and My A.E.D.

“Everyone should have BLS training. . . we’ll all be better off because of it”     -Me.

I arrived at my designated gate at Chicago’s O’Hare Airport.  The run there kept the adrenaline level up in my system, though the hubbub was now well behind. I pulled the crumpled boarding pass out of my pocket as I caught my breath. No that’s a hotel receipt. Check the other pocket, there it is, Zone 3, that can’t be that bad; I thought,  there’s gotta be, what maybe 6 or 7 zones, right? “Welcome aboard American Airlines flight to Flint, Michigan” the gate attendant announced. We welcome our platinum medallion, gold medallion, silver medallion, bronze high-flyers, copper star club, as well as plastic fantastic, and purple star members, followed by zones one and two” The last of the passengers was already through the jetway. “Now boarding zone three, welcome aboard”.

After handing over my crumpled boarding pass for scanning, I made my  down the jetway and onto what appeared to be a small but fairly packed little jet. Passengers on each side of the aisle eyed me as I walked past, a few noticed that my jeans were soaked from the knees down. Some caught the odor that  trailed behind, a light of recognition igniting in their eyes as they realized what it was. Does he really smell like that? Is he the one that’s dragging that awful scent through this cabin?

6 hours earlier things had been going very differently for me. My colleagues and I had just given a well received talk at the annual Chest convention. I had reconnected with old friends that I hadn’t seen since training.  I had just personally  thanked Kevin Pho (of KevinMD fame) in the hotel coffee shop for giving our keynote address and getting our membership fired up about the future of medicine and social media. It was with this sense of excitement and renewed enthusiasm that I boarded my plane to catch a connection at O’Hare.

I also distinctly recall that, at the time, my pants were absolutely one-hundred percent completely dry. Continue reading “Me and My A.E.D.”

The Ones that Emory Didn’t Save

It was with much fan-fare that 2 American aid workers were airlifted from across the world and brought to Emory University Medical Center where they began experimental treatment for Ebola. We hope for a full and speedy recovery for them and others like them who do God’s work.

But it appears to me that lost in this conversation are myriad others who need help but never get it. Right now, humanitarian work is being done all over the world, and in very dangerous places. These people  knowingly put their life on the line for others. Yet  tragically, some of them are injured or sickened in the service of others. But for them, the call from the CDC offering to med-evac them out never came. There was a girl, who died of malaria while in Kenya. Or the young man who was serving in Egypt. Or a myriad other aid workers who die while serving their fellow human beings.

Also at issue, and it needs to be asked, at what cost are we saving lives? Who decides who gets what may have been, all told, a hundred thousand dollar medical evacuation? Susan Grant, the Chief Nurse for Emory Healthcare, in an article for The Washington Post rightly downplayed the infection risk posed by bringing these patients here. She went on to say:

“The purpose of any hospital is to care for the ill and advance knowledge about human health. . . As human beings, we all hope that if we were in need of superior health care, our country and its top doctors would help us get better”

This statement brings to mind others that need saving. They don’t work in far away lands, they live here in the U.S, right across town, in fact. They don’t have fancy, exotic diseases.  Their conditions have names like diabetes, heart disease, hypertension, and lung cancer. Right now many of them are getting collection notices for their inability to pay from medical centers like Emory University. Others have been trying to get appointments at tertiary centers  like Emory. Only they’re told that their insurance is not accepted there, or their co-pays and deductibles will be more than they can afford.

How would Ms. Grant justify the incredible expense spent on this endeavor to those people? What would she say about the necessity of this experiment, a clinical trial with an N = 2? Could she really  tell those sweating in the Atlanta heat after their electricity got shut off that this was all really for their benefit?

I don’t know how to solve the ethical dilemma here. While I am hope for a cure on the one hand, I cringe at the highlight this places on those at the bottom end of America’s healthcare disparity gap. Perhaps someday in the distant future they can take solace in knowing that they didn’t suffer for naught. Because if they ever contract ebola, there will be a cure waiting for them.

How to Fix Healthcare, From a Doctor on the Frontlines: Part 3.

This is the last of a 3 part series by Dr. Moeller, the infamous Doctor on the Frontlines. In this series he explores ways in which our healthcare system is failing, and how it can be improved from the perspective of those who live and breathe healthcare every day. . . doctors. Click the links to read Part 1 and Part 2.

I want every person in America to have access to quality health care all at a reasonable price because our citizens deserve this. Unfortunately, universal access to care at a reasonable price cannot materialize unless lawmakers look to doctors on the front lines of care for specific input.  We as doctors know in many ways why costs are high and why the public is unfortunately misinformed about how it all works.  But we need a representative sample of practicing doctors in Congress discussing these issues so that these “insider” insights can be applied to our current laws. In post, I look at the last of three central  ideas that would lead to better and more affordable care.

3. Health Savings Accounts.

The third solution highlights increasing patients’ roles in their own health, which would lead to more patient satisfaction, and actually lower costs.  This could be accomplished with health savings accounts.  These accounts would be funded by patients with pre-tax dollars and contributions made by employers and/or government subsidy stratified based on the individual’s income and job status.   With actual money in these accounts, patients would be able to discern costs better and use this money as if they were consuming any other good or service, such as handyman services.   This money could grow each year like an investment account and even be passed on to heirs at the time of death, keeping that sense of ownership with loved ones. Continue reading “How to Fix Healthcare, From a Doctor on the Frontlines: Part 3.”