Helping make the health care system work for you

Doctor's orders: The value of comparing drug prices

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"You forgot to tell me the biggest side effect of my medication," Dr. Sharon Orrange recalls a patient telling her: "The cost."

Dr. Sharon Orrange recently heard me on KPCC's AirTalk discussing the wide variation in the cost of back MRIs, as part of our #PriceCheck collaboration.

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.

Price problems

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.

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Did your newborn get a Vitamin K injection?

Rebecca Plevin/KPCC

South Coast Midwifery and Women's Health Care gives parents the option of choosing the Vitamin K injection for their newborn, oral Vitamin K drops, or foregoing Vitamin K all together.

Rebecca Plevin/KPCC

Dr. Valencia Walker checks on an infant in the neonatal intensive care unit at UCLA hospital in Santa Monica.


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.

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Why are poor diabetics more likely to lose limbs?

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Benjamin Brayfield/KPCC

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.

Why?

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.

Hope

Florido kept digging, and found a Boyle Heights doctor who says there's more to the story.

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Robin Williams' death: An opportunity to prevent more suicides

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Benjamin Brayfield/KPCC

Items are left in memory of Robin Williams on his star along Hollywood Boulevard.

Something positive may come out of the tragedy of Robin Williams' apparent suicide: Suicide prevention hotlines are seeing a spike in calls from people seeking help.

The 160 local hotlines that make up the National Suicide Prevention Lifeline saw their collective call volume more than double in the 24 hours after Williams' death, according to Lifeline officials.

In Los Angeles, the folks manning the phones at the Didi Hirsch Suicide Prevention Center — the nation’s oldest and largest — are reporting a similar phenomenon. There has been a 95 percent spike in calls since Williams' death, from about 160 a day to more than 300 a day, says Center Director Robert Stohr. 

The comedians' death seems to have had a particularly strong impact among Latinos experiencing mental health crises, if calls to the Center's Spanish language line are any measure. Before Williams' death, there were a couple of calls a day, and since then there have been more than 50 a day, Stohr says.

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Doctor consultation apps: Healthy or harmful?

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Photo by Jhaymesisviphotography via Flickr Creative Commons

Have you ever visited with your doctor via the camera on your smartphone or computer?

Have you ever visited with your doctor via the camera on your smartphone or computer? Could this soon become the norm for minor conditions?

Doctor consultation apps seem to offer incredible convenience: For basic but annoying health issues, they could possibly replace a visit to urgent care. After a virtual consultation, doctors can prescribe antibiotics and common medications, if needed. The virtual appointments are often available for a flat fee that ranges from $40 to $50 per visit, depending on which app you use. Some offer monthly subscription rates.

But as Heather Somerville reports for the San Jose Mercury News, these apps also come with potential pitfalls.

For one, Somerville writes, patients are using the apps for conditions that, while common, typically require diagnostic tests – like strep throat, bronchitis, ear infections and urinary tract infections.

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