Helping make the health care system work for you

Advanced dementia patients often prescribed unnecessary drugs, study finds

Hospice Cares For Terminally Ill During Final Stage Of Life

John Moore/Getty Images

More than half of long-term nursing home residents with advanced dementia received at least one "questionably beneficial medication," according to the study in JAMA Internal Medicine.

More than half of long-term nursing home residents with advanced dementia are receiving at least one "questionably beneficial medication," according to a new study in JAMA Internal Medicine.

The authors of the study conclude there's a high use of unnecessary, inappropriate drugs for terminally ill dementia patients, whose goal of care should be comfort, not prolonging life.

If this sounds familiar, it's because appropriate end-of-life care is a common theme on this blog. Recently, I reported on a study finding that providing futile care in the intensive care unit could hurt another patient's chances of getting needed treatment.

The study

The study relies on information collected from the prescription-dispensing database of a national long-term care pharmacy that operates in 47 states, according to the report. It assessed the drugs prescribed to 5,406 nursing home residents with advanced dementia between October 1, 2009, and September 30, 2010.


Doctor calls for action on 'crazy' health costs

Would a doctor dressing neatly affect your rating?


Should doctors play a role in the push for greater transparency in health costs?

As it turns out, even doctors are shocked by the wide variation in charged prices for certain medical procedures.

Dr. Stephen Rakower was the chairman of several surgery departments in Orange County before he retired in 2010. In his career, he told me, he ordered several thousand ultrasounds and CAT scans.

But it wasn't until recently, when a relative needed a radiology procedure, that he learned there exists a wild variation in charges for many common procedures, like mammograms and back MRIs. And, he learned, patients typically don't know how much of the bill they'll be responsible for until long afterward.

He reached out to our ongoing #PriceCheck project to say that he – and most likely other doctors, too – has no idea how widespread and deeply ingrained this phenomenon is.


More California parents opting out of vaccinating their kids

A student gets vaccinated against pertussis at a Los Angeles middle school in 2012. The state required that students be immunized to halt an epidemic of whooping cough.

Kevork Djansezian/Getty Images

California parents are opting out of vaccinating their children at twice the rate they did seven years ago, according to a Los Angeles Times investigation.

Are the rates of vaccine exemptions increasing at schools in your community? Or have school officials succeeded in lowering the rates of personal belief exemptions? We want to hear about the situation at your local school.

Losing herd immunity

More and more parents are choosing to opt out of vaccinating their children, due to personal beliefs, the Los Angeles Times reported Wednesday.

Reporters Paloma Esquivel and Sandra Poindexter analyzed immunization data over seven years and found:

  • California parents are opting out of vaccinating their kids at twice the rate they did seven years ago. The growth in these "personal belief exemptions," which are legal, was particularly prevalent at private schools, the Times reports.
  • Health experts say a school loses "herd immunity" (protection of most members of a community as a result of high vaccination levels) when 8 percent or more of the students are unvaccinated, according to the Times. The paper reports that nearly one in four private kindergartens reported at least 8 percent of their students were exempt from at least one vaccine last fall, due to personal beliefs, the Times reports.
  • In Los Angeles County, the increase in personal belief exemptions is most pronounced in wealthy coastal and mountain communities. The more than 150 schools with exemption rates of 8 percent of higher  for at least one vaccine were in census tracts with average incomes of $94,500, the Times reports.


How much should a vasectomy cost?

Filling out the forms is part of the ritual of going to the doctor. But with the Affordable Care Act, it's more complicated.


Vasectomies have traditionally been covered by insurance. But they're not included under the Affordable Care Act's contraception mandate, according to the Guttmacher Institute.

In this great episode of the WNYC podcast Death, Sex and Money, blogger and stay-at-home dad Clint Greagen describes how he made the decision to get a vasectomy.

Greagen tells host Anna Sale that his wife brought up the idea of a vasectomy when she was pregnant with their fourth – and final – son. He agreed to do it, but:

"It was probably about two years after we first brought it up before I actually got into gear and got the job done."

His decision

He explains why he hesitated:

"…the two biggest things I worried about was all the inspections that had to go on with my genitals in front of other people, and the second thing was actually having my genitals pierced by sharp objects."

Another reason, he tells Sale, was the knowledge that he wouldn't be able to father any more kids:


Does 'futile' care needlessly clog the ICU?

Hospitals need to cut patient load

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."

Futile care

Before we dive into this debate, let's back up. What's futile care, anyway?