Health and Disability

Potential adverse effects of antipsychotic drugs include reduced alertness, a higher risk of diabetes and heart disease, low blood pressure and, in the long term, movement disorders that resemble those seen in Parkinson's.

Previous studies have suggested that psychotic drugs may cause higher rates of mortality among patients with dementia, and the FDA warning notes the risk to patients with dementia.

Most people with dementia have Alzheimer's disease, but there are other forms of dementia, and one of these occurs in around 80% of individuals with Parkinson's, usually some years after diagnosis.

In 2011, Dr. Daniel Weintraub, senior author of the current study, and colleagues found that despite these warnings, there was little action to reduce prescriptions of antipsychotic for patients with Parkinson's.

The researchers compared 7,877 Parkinson's patients who received prescriptions for antipsychotic drugs at any time from 1999-2010 with a control group that did not use the drugs.

They matched participants for factors such as age, ethnicity, gender, years since diagnosis and presence of dementia.

Results showed that in the 180 days after starting antipsychotic drugs, the rate of mortality among those taking the drugs was 2.35 higher than among those who were not.

Those taking quetiapine had a 2.16 higher risk compared with no treatment; with risperidone, the risk was 2.46 times higher, with olanzapine, 2.79 times, and haloperidol was associated with a 5.08 times higher rate of mortality.

Overall, first-generation antipsychotics, such as haloperidol, appeared to entail a 50% higher relative risk of mortality than more recently developed antipsychotics - for example, risperidone and quetiapine.

A new study conducted by Premier, Inc. and published in the Journal for Healthcare Quality suggests women and Medicarepatients are more likely to be readmitted to a hospital. It also found that COPD and heart failure are among the top five disease states driving readmissions.

It evaluated readmission rates from approximately 15 million inpatient, all-payer discharges across more than 600 diverse hospitals. The study found that factors such as income, gender, age and payer status all showed a strong statistical significance in predicting readmissions within 30 days. Specifically, it suggests that the odds for heart attack patients being readmitted were:

• 17% higher for women than men.
• 24% higher for Medicare patients versus those with commercial insurance.

In addition, the lower the income and older an individual, the more likely they were to be readmitted. These findings suggest that readmission rates are closely linked to a patient's socioeconomic status.

Kim Hiatt had worked as a nurse for 24 years when she made her first medical error: She gave a frail infant 10 times the recommended dosage of a medication. The baby died five days later.

Hiatt's mistake was an unnecessary tragedy. But what happened next was an unnecessary tragedy, too: Seven months after the error, Hiatt killed herself.

"She fell apart," her mother, Sharon Crum, says. "I suppose it would be the same thing you felt, if you felt at fault for a child's death."

This is a story about Hiatt, the mistake she made, how she struggled with that tragedy, and how the institutions that had previously supported her ultimately shut her out.

It is also a story about an open secret in American medicine. Medical errors kill more people each year than plane crashes, terrorist attacks, and drug overdoses combined. And there's collateral damage that often goes unnoticed: Every day, our healers quietly live with those they have wounded or even killed. Their ghosts creep into exam rooms, their cries haunt dreams, and seeing new patients can reopen old wounds.

"Every practicing physician has either made an error that harmed a patient or certainly been involved in the care of a patient who has been harmed," says Albert Wu, who directs the Johns Hopkins Center for Health Services and Outcome Research.

A new line of research that Wu began in the 1990s has found that many health care providers experience anguish, turmoil, and emotional trauma in the wake of a serious medical error. The providers are, in Wu's view, "second victims" of the mistake.

Just like their patients, these providers struggle to make sense of how an effort to heal turned into serious harm. One 2009 study found that two-thirds of providers reported "extreme sadness" and "difficulty concentrating" in the wake of harming a patient. More than half experienced depression; one-third said they avoided caring for similar patients afterward, for fear of making a similar mistake. Some consider suicide — and a smaller fraction, like Hiatt, take their own lives.

The high price of prescription drugs is an issue of great concern to most Americans and has even attracted theattention of presidential candidates from both parties. Although the growth rate was slower than in the previous year, prescription drug prices continue to outpace price growth for other health care sectors. It’s no wonder then that CMS is taking action to try to reduce drug spending. But strong pushback from the drug industry, among others, illustrates why tackling high drug prices remains such a challenge.

The current proposal takes aim at a perverse incentive in Medicare Part B that pays physicians a percentage of the cost of a drug they administer in their office. As a result, reimbursement is much higher for higher cost drugs. But the proposal started drawing fire before it was even unveiled. Opponents have mischaracterized the proposal as interfering with clinical decision making, but in reality it does nothing of the sort. It is merely designed to remove the financial incentive to administer more expensive drugs. However, many physician groups and patient support groups have joined PhRMA in opposition. It will be interesting to see whether CMS stays the course or whether the general but diffuse societal interest in lower drug prices will be trumped (can I still use that word?) by the intense interest of those who are most closely affected.

We sent two surveys to about 400 people who had either muscular dystrophy (MD), multiple sclerosis (MS), post-polio syndrome (PPS), or spinal cord injury (SCI) and said they had chronic pain. We sent the two surveys about three years apart. On the first survey, we asked questions about pain acceptance, such as “I am getting on with the business of living regardless of my pain”. Then, on both surveys, we asked people how bad their pain was, how much it got in the way of their lives and activities, how well they could do physical tasks, and questions about any problems with mood or sleep. We looked at how the participants’ answers to these questions changed over the three years, and if they were related to how much they accepted their pain in the first survey.

If you have chronic pain, staying involved in activities despite pain may help you feel better over time. Here are some ways to manage your pain and stay active:

• Focus on doing activities that make you happy such as spending time with family and friends, volunteering in your community, or making art or music. If it’s difficult to do everything that you used to do, focus more on a few activities that you really enjoy and give your life meaning.
• Exercise regularly.  Even gentle exercise or stretching, can help manage pain and improve your physical abilities. If you aren’t currently exercising, talk to your healthcare provider or a physical therapist about starting an exercise program.
• Relaxation and meditation can help make pain feel more manageable. In particular, mindfulness meditation involves focusing your attention on the present moment and becoming more aware of your thoughts and reactions to pain. Learn more about mindfulness meditation here.

Things you should know:

• Staying involved and engaged in life despite pain can improve your well-being over time.
• Happiness is an important part of living well with chronic pain. To learn more, check out our recent paper on the role of happiness in living with chronic pain.

Having a sick child is never easy. But if your child has to be sick, hope for something mechanical: a broken bone, a gash that needs stitches—something that can be physically mended. Failing that, wish for something commonplace. Chickenpox, a bladder infection, bronchitis. Doctors can manage these things with their eyes closed. If pushed, consider the merits of illnesses that are at least well understood—illnesses that can be definitively diagnosed and have generally agreed-upon courses of treatment. What you least want is something obscure, something not yet well characterized—and least of all, something both obscure and pertaining to the mind.

Seven days after the red face, and two days after the swelling had subsided, we knew for certain that our problem was not over. Something new had emerged: our daughter was unable to go to school. On the Monday, she said she was too tired. On the Tuesday, she said she needed another day. But when Wednesday rolled around and she hunkered under the dining room table weeping while her sister set off, we knew something was truly amiss.

At first, we suspected stress. She did well in school, but had lately been frustrated with homework. Could it be that? She said no. Maybe she had been bullied. Had other kids been mean to her? No. Was she unhappy? Was something bothering her? Did her ear still hurt? It was none of these things, she insisted. She really wanted to go, she said. But she couldn’t. She didn’t know why. 

We racked our brains. She was a mostly healthy kid, but had some anxieties. She couldn’t fall asleep on her own, for instance, and couldn’t stand doctors giving her needles, checking her ears or palpating her stomach. But this anxiety seemed different. My mind wandered back to an accident she’d had in the summer, where she’d slammed her head on the sidewalk. Could it be some post-concussion syndrome? It seemed unlikely. Then there was the fact that she’d been diagnosed years earlier with Tourette’s syndrome. Her tics were mostly throat-clearing, blinking and head-shaking—mild enough that her pediatrician was suspicious of the diagnosis—so that didn’t seem a likely cause either. We were stumped. 

There is a debilitating illness out there that's effecting the lives of one in 100 adolescents and young adults and it's known as POTS (Postural Orthostatic Tachycardia Syndrome).

Willie Petty, 14, from Ellicott City is one of them. Sitting at his kitchen table, his legs bounce and his arms flex almost constantly, as he tries reflexively to shake the pain that is so often with him.

Across the table, Candeance Petty watches her son’s anguish and shakes her head.

“He’s almost always in pain — his head, his joints, his chest, his side,” she says. Her voice turns hard. “I ask myself almost every day, ‘How can you go from being healthy for 13 years, from being a healthy infant, a healthy child, an all-star, championship football player, to basically home-ridden? How can you have a head injury — and it changes everything?’”

POTS is a form of dysautonomia, according to the website of the Dysautonomia Youth Network of America (DYNA), a nonprofit organization dedicated to adolescents and young adults dealing with the dysfunction. Dysautonomia is a medical term for a group of conditions caused by a dysfunction of the autonomic nervous system, which controls heart rate, blood pressure and digestion.

The many symptoms of POTS include abnormal spikes in heart rate, dizziness, stomach and joint pain, low blood pressure, fatigue, headaches and gastrointestinal upset. Symptoms vary in severity from patient to patient, but all POTS sufferers have difficulty getting the blood to flow out of their lower extremities to their brain -— which explains many of the symptoms.

Although the condition was recognized in medical literature as far back as the Civil War, the name POTS did not even exist until coined by researchers at the Mayo Clinic in the 1990s. Since then, it has been diagnosed with increasing frequency and now affects an estimated 1 million to 3 million Americans — most commonly adolescents and young adults – according to Dysautonomia International, a nonprofit organization that assists people with dysautonomia. About 80 percent of patients are female, according to the DYNA.

New research indicates that Parkinson’s disease may begin in the gastrointestinal tract and spread through the vagus nerve to the brain.

“We have conducted a registry study of almost 15,000 patients who have had the vagus nerve in their stomach severed. Between approximately 1970-1995 this procedure was a very common method of ulcer treatment. If it really is correct that Parkinson’s starts in the gut and spreads through the vagus nerve, then these vagotomy patients should naturally be protected against developing Parkinson’s disease,” explains postdoc at Aarhus University Elisabeth Svensson on the hypothesis behind the study.

A hypothesis that turned out to be correct:

“Our study shows that patients who have had the the entire vagus nerve severed were protected against Parkinson’s disease. Their risk was halved after 20 years. However, patients who had only had a small part of the vagus nerve severed where not protected. This also fits the hypothesis that the disease process is strongly dependent on a fully or partially intact vagus nerve to be able to reach and affect the brain,” she says.

The research project has just been published in the internationally recognised journal Annals of Neurology.

The research has presented strong evidence that Parkinson’s disease begins in the gastrointestinal tract and spreads via the vagus nerve to the brain. Many patients have also suffered from gastrointestinal symptoms before the Parkinson’s diagnosis is made.

“Patients with Parkinson’s disease are often constipated many years before they receive the diagnosis, which may be an early marker of the link between neurologic and gastroenterologic pathology related to the vagus nerve ,” says Elisabeth Svensson.

When Obamacare was first introduced to Congress, the Congressional Budget Office detailed multiple savings it would provide to many, and not just the 18-to-64 population who would finally get affordable insurance. The Affordable Care Act would even save Medicare – health coverage for seniors and the disabled – $463 billion over 10 years, too, CBO said in initial analysis.

As expected, Republicans challenged the claims, saying the estimates were unrealistic. And for once, they were right – but not for the reasons they claim.

Obamacare will not save $463 billion from Medicare, a more recent CBO report shows. Instead, it’s saving $1.07 trillion in the 10-year period of 2011-2020.

A recent Commonwealth Foundation report explains how those Medicare savings came about. You see, Obamacare also created new regulations for hospitals serving Medicare recipients, insisting that better care be provided. 

This lower rate of hospitalization overall contributed to the reduction in overall Medicare spending, but so did other factors. Better first-visit service to Medicare patients in both hospitals and in doctors’ offices, combined with better availability of covered medications, contributed significantly, too. That’s how the 2014 data on expenses wound up far below CBO’s 2009 projections.