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'Death Panels' Redux - FactCheck.org

Q: Did an emergency-room physician in a Tennessee hospital say the new health care law is currently denying dialysis to some Medicare patients, and will deny care to those over 75 in 2013?

A: No. A spokesman for the hospital says the doctor never said the things attributed to her in a chain email, and they are not true. A guest in the doctor’s home fabricated the account.

FULL QUESTION

This email seems like hooey. Can you investigate? Thanks.

I had one of the most troubling, most disturbing conversations ever with Julie’s sister-in-law, Dr. Suzanne Allen, head of emergency services at the Johnson City Medical Center in Tennessee.

We were discussing the “future” and I asked her had she seen any affects of Obama Care in her work?

“Oh, yes. We are seeing cutbacks throughout the services we provide. For example, we are now having to deal with patients who would normally receive dialysis can no longer be accepted. In the past, there was always automatic approval under Medicare for anyone who needed dialysis — not anymore.” So, what will be their outcome? “They will die soon without dialysis,” she stated.

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This applies to major operations such as receiving stents, bypass surgery, kidney operations, or treating for an aneurysm that would be normally covered under Medicare today. In other words, if you needed a life-saving operation, Medicare will not provide coverage anymore after 2013 if you are 75 or over. When in 2013? “We haven’t been given a specific date — could be in January or July….but it’s after the election.”

This is shocking to any of us who will be 75 this year. Her advice — get healthy and stay healthy. We do not know the specifics of the actual implementation of the full Obama Care policies and procedures — “they haven’t filtered down to the local level yet. But we are already seeing severe cuts in what we provide to the elderly — we refused dialysis to an individual who was 78 just the other day….we refused to give stents to a gentleman who was in his late 80s.” Every day, she said, we are seeing these cutbacks aimed at reducing care across the board for anyone who is over 75.

We can only hope that Obama Care will be overturned by the Supreme Court– otherwise, this is a death sentence to those who are over 75….perhaps you should pass this on to your friends who are thinking of voting for Obama this year.

Regardless if you have private health care coverage now (I have Aetna Medicare Part B) — it will no longer apply after 2013 if the Ethics Panels disapprove of a procedure that may save your life.Scary, scary, scary. Think about this? You? Your parents? Your loved ones?

Didn’t know about it? Of course, not. As Nancy Pelosi said….”well, if you want to know what’s in the bill, you’ll have to read it…..” After it was passed.

This is a graphic reminder of the need to stay healthy. Get your plot now at Forest Lawn….while they last. Is this a death sentence to those of us who will reach 75?…..Yes!

FULL ANSWER

The frightening claims in this email about losing control of one’s health care decisions have caused consternation among some of our readership — particularly the fear of losing all health care after age 75. But fear not, this email is bunkum.

The email presents a veneer of authenticity. There is, in fact, a Johnson City Medical Center. It is a not-for-profit center located in Johnson City, Tenn., that serves as “a safety net hospital caring for the uninsured.” And there is a Dr. Suzanne Allen who works in emergency medicine at that center. But that is where any truth to this email ends.

We contacted Ed Herbert, a representative for the Johnson City Medical Center. He confirmed to us that the conversation quoted in the email is fraudulent. According to Herbert, a guest of Dr. Allen’s home created the untrue email to further a political point.

Ed Herbert, April 19: The conversation is not true. The originator of the blog/email was a guest in Dr. Allen’s home. He is using Dr. Allen’s name and that of Johnson City Medical Center (JCMC) to wrongly promote his political position. …[Dr. Allen] was very upset that the individual would fabricate a conversation about healthcare reform and use her name to add credibility to his position.

The statements attributed to Dr. Allen were not said, the statements about Johnson City Medical Center are not true. The healthcare reform law, according to Dr. Allen, does not change the way in which she cares for her patients. From a hospital point of view, if there has been any effect from the healthcare reform law, it has been increased access for patients.

In addition to weaving a yarn based on a fake conversation with a doctor, the email is also factually inaccurate in its claims about the health care law. Nowhere in the thousands of pages of the Patient Protection and Affordable Care Act passed in 2010 is there any mention of “ethics panels.” In addition to that, the law makes no mention of any provisions specifically affecting those 75 and older.

These panels are a relabeling of the infamous “death panels” used by detractors of the law two years ago. As we have said several times before, there are no death panels in the health care law. A provision to have Medicare cover the cost of optional end-of-life counseling spurred the claim, but was dropped from the bill before passage.

Others have claimed an Independent Payment Advisory Board created by the law will be charged with rationing care. The 15-member IPAB — made up of doctors and medical professionals, economists and health care management experts, and representatives for consumers and seniors — is tasked with finding ways to reduce the growth in Medicare spending. But as we have noted before, the law explicitly says that the IPAB’s proposals “shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums … increase Medicare beneficiary costsharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria.” (See page 490.)

While this cock-and-bull story has spread well beyond its origin in Tennessee, there is no validity to the claims it makes and readers should feel free to purge it from their inboxes.

– Scott Blackburn


Sources

Herbert, Ed, a spokesman for the Johnson City Medical Center. Email sent to FactCheck.org. 19 Apr 2012.

The Patient Protection and Affordable Care Act. Pub. L. 111-148. Enacted 23 Mar 2010.

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Aliskiren (Tekturna) Gets New Warning and Contraindication From FDA - Forbes

Aliskiren (Tekturna) Gets New Warning and Contraindication From FDA
Forbes
The FDA now states that these drug combinations are contraindicated in patients with diabetes, and it is adding a new warning to avoid the use of this combination in patients with moderate to severe renal impairment (GFR <60 mL/min).
New Warning, Contraindications Announced for Aliskiren-Containing Drugs Family Practice News Digital Network
No aliskiren with ACE inhibitors, ARBs in some patients: FDA TheHeart.Org
FDA Warns of Aliskiren Combos MedPage Today
Reuters  - Cardiovascular Business  - Bioscience Technology
all 19 news articles »

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Fire in New Civil Hopistal, 12 patients rescued - Times of India

SURAT: At least 12 patients and their relatives in the kidney dialysis centre of New Civil Hopistal (NCH) were rescued on Friday afternoon following a fire incident due to short circuit.

Official sources said one of the dialysis equipment in the department caught fire due to short circuit and at least 12 patients and their relatives were stuck inside the smoke filled room.

The fire and emergency service department rescued the victims.

Chief fire officer Pankaj Patel told TOI, "It is unfortunate that a government hospital is lacking in fire safety provisions. The dialysis department didn't have a fire extinguisher even for emergency use. We have asked the hospital authorities to comply with the fire safety and protection norms."

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Positive CHMP Opinion In Europe Of Ferumoxytol For Iron Deficiency Anemia In ... - Science 2.0 (press release)

The Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has issued a positive opinion for ferumoxytol, a new intravenous (IV) iron therapy with a proposed indication for the treatment of iron deficiency anaemia (IDA) in adult patients with chronic kidney disease (CKD). 

Ferumoxytol is an IV iron therapy with a proposed indication for the treatment of IDA in adult patients with CKD. Its structure and formulation allows for the administration of 510 mg in a shorter time frame than existing IV iron preparations. Ferumoxytol significantly increases Hb levels in CKD patients both on dialysis and in patients not on dialysis compared with oral iron. Clinical trials have also highlighted that ferumoxytol is well tolerated.

Ferumoxytol was developed by AMAG Pharmaceuticals, Inc and is marketed outside the US by Takeda Pharmaceuticals following announcement of a comarketing agreement in March 2010. Ferumoxytol is currently approved for use in Canada and the US as Feraheme®. 

The CHMP opinion was based on data from three pivotal phase III clinical trials where ferumoxytol was administered as a rapid injection.[1,2,3] Each of the three pivotal safety and efficacy studies achieved statistical significance in its primary endpoint: the mean change in haemoglobin (Hb) from baseline at Day 35 after the first dose. Ferumoxytol significantly increased Hb levels as compared to oral iron across the spectrum of CKD.[1,2,3] Overall, 1,726 subjects were exposed to ferumoxytol in the development program, including 1,562 patients with all stages of CKD.[2]

These studies also showed ferumoxytol was well tolerated by CKD patients with IDA and had a similar treatment related adverse event rate to oral iron.[1] These outcomes were also supported in additional retrospective observational data from three large haemodialysis clinics in the United States involving more than 8,600 patients and more than 33,300 administered doses of ferumoxytol (nearly 50% of patients received repeat dosing with 4 or more doses). In this data set, mean Hb increased 0.5-0.9 g/dL post-treatment and mean Hb stabilised in the range of 11-11.7 g/dL over the 10 month post-dose period with no new safety signals identified with repeat dosing.[4,5]

Iron deficiency is a common cause of anaemia often seen in the later stages of CKD, as renal function deteriorates and erythropoiesis (red blood cell production) declines. IDA can have a profound impact on patients' lives, causing fatigue, shortness of breath and an increase in the risk of cardiovascular (CV) complications including congestive heart failure.[6,7]

"This positive CHMP opinion marks an important step forwards for ferumoxytol. Takeda are looking forward to making this valuable new therapeutic option available to clinicians" said Trevor Smith, Head of Commercial Operations, Europe&Canada, Takeda Pharmaceuticals.

"Iron deficiency anaemia can be a debilitating condition for chronic kidney disease patients and appropriate management of this condition carries positive clinical implications for patients. Therefore, treatment of anaemia at all stages of CKD is essential and the potential availability of ferumoxytol offers an additional therapeutic option to help effectively and conveniently manage this condition." Iain Macdougall, Consultant Nephrologist and Professor of Clinical Nephrology at King's College Hospital, London.

References:

(1) Spinowitz BS, Kausz AT, Baptista J, et al. Ferumoxytol for treating iron deficiency anemia in CKD. J Am Soc Nephrol 2008; 19: 1599-1605

(2)AMAG Pharmaceuticals. Data on file.

(3) Provenzano R, Schiller B, Rao M, et al. Clin J Am Soc Nephrol 2009;4:386-3935 

(4) Schiller B, Bhat P, Sharma A, Li Z, Fortin G, McLaughlin J, Strauss W. Safety of Feraheme® (Ferumoxytol) in hemodialysis patients at 3 dialysis chains over a 1-year period. J Am Soc Nephrol 2011;22:477A-478A. Abstr FR-PO1573.

(5) Sharma A, Bhat P, Schiller B, Fortin G, McLaughlin J, Li Z, Strauss W. Efficacy of Feraheme® (Ferumoxytol) administration on target hemoglobin levels and other iron parameters across 3 dialysis chains. J Am Soc Nephrol 2011;22:485A. Abstr FR-PO1603

(6)O'Mara NB. Anemia in patients with chronic kidney disease. Diabetes Spectrum 2008;21:12-19.

(7) National Kidney Foundation. KDOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. Am J Kidney Dis 2006;47(suppl 3):11-1458


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Antimicrobial Locks in HD Catheters for May Have a Down Side - Renal and Urology News

Antimicrobial locks (AML) decrease the incidence of catheter-related bloodstream infections in hemodialysis (HD)patients, but they may result in the emergence of problematic pathogens, according to British investigators.

In a retrospective study, John J. Dixon, MD, and colleagues at St. Helier Hospital in Carshalton, Surrey, found that AML containing vancomycin and gentamicin significantly decreased the incidence of catheter-related bloodstream infections from 8.50 to 3.80/1,000 catheter-days. However, the proportion of Gram-positive bacteria, notably Staphylococcus aureus, increased significantly with AML use, although the proportion of methicillin-resistant S. aureus and vancomycin resistance did not, the researchers reported online ahead of print in Nephrology Dialysis Transplantation.

The study also found that AML use was associated with increased gentamicin and ciprofloxacin resistance among Enterobacterspecies, but not among Pseudomonas species or Escherichia coli.

Dr. Dixon's team noted that catheter-related bloodstream infections caused by S. aureus are highly pathogenic, with studies showing that it associated with 22% in-hospital mortality, rising to 32% at 90 days. Enterobacter bacteremia has a mortality rate of 5%-20%, increasing to 44% in patients who develop endocarditis. “It seems logical that resistant Enterobacterwill be harder to treat with consequent higher mortality,” the authors stated.

“Given the prevalence of S. aureus and resistant Enterobacter, there is a need for a trial directly comparing the effectiveness of AML with non-antibiotic locks (e.g. citrate) in reducing CR-BSI,” they wrote. Non-antibiotic locks do not promote antimicrobial resistance and may be more cost-effective, they noted.

The study included 927 hemodialysis patients, of whom 662 received vancomycin and gentamicin systemically as well as in an AML. The other 265 patients received only systemic vancomycin and gentamicin and served as a control group.

The proportion of S. aureus cultures was 37.7% in the AML group compared with only 28.6% of the control arm. In the AML group, 29.4% of Enterobacter isolates were resistant to gentamicin, 23.5% were resistant to ciprofloxacin, and 15.7% were resistant to both drugs. In the control group, none of the Enterobacter isolates were resistant to gentamicin and 2.9% were resistant to ciprofloxacin. None of the isolates was resistant to both drugs.

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