Tim Samoff/Flickr Creative Commons
Over a three month period, 11 percent of ICU patients received futile care, according to a new journal article.
If a patient in the intensive care unit is receiving futile care, can that hurt another patient’s chances of getting needed treatment? In the journal Critical Care Medicine, researchers from UCLA and RAND Health conclude: Yes.
"Virtually no one worries that health resources that get used in one area, might be affecting the treatment that others receive, and this is a sort of fact check," Dr. Neil Wenger, a professor at UCLA's David Geffen School of Medicine and one of the article's authors, tells Impatient.
"The reality of the situation is that for treatments that many people really need and most people want, there can be limitations," he continues. "One of the limitations is when the treatments are used ineffectively."
Before we dive into this debate, let's back up. What's futile care, anyway?
+mara/Flickr Creative Commons
Next up in our #PriceCheck project, we're crowdsourcing the cost of something a little more private: IUDs and vasectomies.
Next up in our #PriceCheck project, we're crowdsourcing the cost of something a little more… private: Intrauterine devices, or IUDs.
This small, T-shaped device is inserted into a woman's uterus to prevent pregnancy, and can last there for seven years to more than a decade. (Men, feel free to submit your costs for an even longer-lasting form of birth control: Vasectomies.)
Sheri Bonner, president and CEO of Planned Parenthood in Pasadena and the San Gabriel Valley, tells me this form of birth control is becoming more popular.
About 5 percent of her patients get IUDs. That lines up with figures in a recent Guttmacher Institute report, which found that about 5.6 percent of contraception users chose IUDs in 2010.
The IUD got a bad reputation in past decades due to concerns about pelvic inflammatory disease. But, Bonner says, the devices on the market now - the copper ParaGard and the hormonal Mirena – "are light years away from that and extremely safe."
"You forgot to tell me the biggest side effect of my medication," Dr. Sharon Orrange recalls a patient telling her: "The cost."
Orrange, an internist at the Keck USC School of Medicine, reached out to me via e-mail to say that the lack of transparency with imaging costs is similar to what's happening with the cost of prescription drugs.
I was intrigued. I recently read that one California hospital charged $10 for a blood cholesterol test, while another charged over 1,000 times more. But I didn't know the price craziness extended to prescription drugs.
Orrange and I recently spoke by phone. Traditionally, she told me, doctors have been "abysmal" at talking to patients about the cost of the drugs they're prescribing. And patients, she said, were embarrassed to ask about the price.
Parents, did you provide your newborn with the Vitamin K injection?
As I report today, doctors have given this shot for decades. They say it's extremely effective at preventing spontaneous bleeding, which can cause severe problems and even death.
I met Dr. Valencia Walker, a neonatologist and assistant clinical professor at the David Geffen School of Medicine at UCLA, who recommends the shot for all of her patients.
"When you look at something like a one-time shot, versus having a baby that can die from something that is completely preventable… that's why we do the Vitamin K injection for all of our babies," Walker says.
Refusing the shot
But a small number of parents are refusing the shot. It's hard to know how many people are turning it down. The Centers for Disease Control and Prevention says the information is not tracked by any agency at the county, state or national level.
A diabetic patient waits for an examination at the New Hope Podiatry Clinic in East Los Angeles.
A recent study from UCLA found that diabetics in low-income neighborhoods – like East Los Angeles – are up to 10 times more likely to have a toe, foot or leg amputated than diabetics living in wealthier, west L.A. neighborhoods.
When the study came out earlier this month, KPCC's Adrian Florido reported that while diabetes-related amputations have declined overall in recent years, black and non-English speaking men older than 65 are still especially at risk for them.
At that time, Florido spoke with Dr. Carl Stevens, the study's lead author. Stevens said a key factor is the lack of early and effective diabetes treatment for lower-income people.
Also, he said, there are fewer primary care doctors in poor neighborhoods, compared with wealthier ones.
Florido kept digging, and found a Boyle Heights doctor who says there's more to the story.