By John Ballard
If you need medical care, July is a good time to stay out of teaching hospitals. This NPR report got my attention.
A new study has documented a bit of anecdotal medical wisdom. It's called the July effect. And it happens this month every summer, when thousands of new doctors arrive at hospitals to begin their residency programs and take care of patients for the first time.
The notion that some of these rookie doctors would bungle their responsibilities because of inexperience and sleep deprivation has long been a hospital ward myth. David Phillips wanted to find out if the July effect is more than just a myth. He's a professor of sociology at the University of California, San Diego. His study was published in the Journal of General Internal Medicine, and he joins us now. Welcome to the program.
Mr. DAVID PHILLIPS (Professor of Sociology, University of California, San Diego): I'm happy to be here.
NORRIS: How did you go about this study, in trying to figure out if there was something to this July effect?
Mr. PHILLIPS: Well, I looked at about 250,000 medication error deaths over a period from 1979 through 2006, and no one previously had been able to look at such a large sample of deaths. And I think that may be one reason why no one previously had found this July spike that we did.
NORRIS: And did you, as I understand, compare counties without teaching hospitals with counties that actually had teaching hospitals?
Mr. PHILLIPS: Yes, that was one of the things we did. And we found that this spike in July deaths from medication errors appears only in counties that have teaching hospitals. And you find this July spike in medication error deaths, but you don't find any equivalent spike in July in any other cause of death.
Deaths from medication errors are increasingly frequent, and it's now true that accidental deaths from medication errors constitute the second leading kind of accident in this country. Only motor vehicle accidents are more frequent.
Sure enough, CNN also did a report.
More than 16,000 U.S. medical school graduates are awarded M.D. degrees each year, and many enter their residency programs at teaching hospitals in July. Now, a growing body of research suggests that month might be a more deadly time in U.S. hospitals.
According to a recent study from the University of California, San Diego, deaths from medication errors increase by 10 percent during July, a so-called July effect as students graduate from medical school and enter residency programs.
Researchers examined more than 240,000 death certificates of people who died of complications from medication errors between 1979 and 2006, and found mortality rates consistently spiked in July, especially in counties with teaching hospitals.
No need for commentary from me. The data speak for themselves. Several questions remain as listed in the report. (6 pages pdf)
Is there a July Effect for non-fatal medication errors? What are
the detailed mechanisms contributing to the July Effect (e.g.,
miscommunication, inadequate oversight)? Why is there a July
spike in fatal medication errors but not in fatal surgical errors?
In light of the stats, the unanswered questions are more disturbing than the results of the report. Short of getting killed, what might be the non-fatal consequences of medication mistakes? And as Dr. Phillips mentioned in the NPR interview, it's possible that surgical errors are less likely thanks to reliance on surgical teams rather than the sole decision-making of an individual doctor.
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My personal reaction is that as a society a heavy reliance on drugs lies at the heart of the problem.
Not only do medical (and other) professionals lean too heavily on drugs, so too do we as patients.
All those DTC ads in prime time TV don't help.
I notice locally that here in the Bible Belt, just a few years away from dry counties and blue laws, politicians still make political points by cracking down on pill mills. I'm not sure, incidentally, that this is altogether a bad development. This is from the Atlanta paper in March.
If you're looking for easy access to prescription painkillers, you'll have to bypass Kennesaw.
That's the message city leaders sent Wednesday night when they voted unanimously to put a one-year moratorium on the opening of new pain clinics not affiliated with hospitals, drug treatment centers or hospices. The measure, proposed by Kennesaw Police Chief William Westenberger, was an attempt to weed out so-called "pill mills" from legitimate medical clinics.
Police said pill mills usually are owned by private investors who hire doctors as subcontractors. They feed prescription-drug addiction by doling out large quantities of drugs like OxyContin and morphine with minimal screening of patients.
Kennesaw Police Lt. Craig Graydon told the City Council that pill mills are "like fast-food restaurants for powerful prescription narcotics."
Local governments in Cobb County became alarmed after a suspicious clinic called Pain Express opened in Kennesaw last month and quickly attracted customers from other states. The clinic has closed, but community members were concerned that failing to take preventative action could cause more to appearin its place.
Cobb County commissioners last week voted to reject zoning, permit or license applications from new medical clinics through June 30. The Marietta City Council also is considering a moratorium on new pain clinics.
Kennesaw Mayor Mark Mathews said he hopes lawmakers at the state Capitol will take action to crack down on pill mills before the moratorium expires. The state Senate this year passed a bill that would create a prescription drug monitoring program and allow law enforcement to track prescriptions through an electronic database. Similar programs exist in 39 other states. The bill is currently before the House.
And this appeared last week.
A second Cherokee County city has passed a moratorium on business licenses granted to pain management clinics, also known as "pill mills."
The Woodstock City Council on Monday night unanimously approved a one-year moratorium on issuing licenses to new pain management clinics within the city limits.
The council also directed city staff to investigate writing an ordinance that would further regulate these businesses.
The moratorium comes on the heels of a pill mill bust in Holly Springs earlier this year.
The Holly Springs Police Department shut down a suspected pill mill operating as a chiropractic center. The Holly Springs City Council has also passed a moratorium on issuing licenses to such businesses.
The phenomenon of pill mills are sprouting up all across the country, but Broward County, Fla. has borne the brunt of the problem, said Woodstock Police Chief David Bores.
According to the chief, in 2007, Broward only had four pain clinics operating. In 2008, the county had 66 pain management clinics. That number more than doubled by November 2009, with 176 operating in Broward County.
Unlike legitimate pain management clinics, pill mills do not write prescriptions for patients, but rather allow patients to choose which drugs they want. Patients also often pay in cash for the medication, which includes hard-hitting pain medication such as Oxycontin.
Bores requested the moratorium to "get a handle on the problem" before any popped up in Woodstock. The city has three pain management clinics, but there have been no problems so far, he said.
Bores added his decision was in part due to a discussion by the Cherokee-Multi Agency Narcotics Squad's Control Board. The chief said the board would like to see all Cherokee cities pass moratoriums on issuing licenses to such facilities.
CMANS Commander Phil Price said legitimate pain management clinics operate with the health of patients as a top priority. Pill mills, he said, don't, noting they don't test patients to see if they are suffering from liver toxicity because of an overload of medication.
"They will make sure the health isn't compromised," he said of legitimate clinics. Pill mills "are places were the patients write the prescriptions."
Price added CMANS and the Cherokee Sheriff's Office are aware of some pain management clinics that have moved into the area. The agencies are closely watching them for suspected illegal activity.
I find local news boring because stories like these do nothing to find the roots of the problem
As in the case of marijuana and other illegal substances the problem is one of demand, not supply.
Our belief in the power of pills approaches religious extremes. And what we believe very often countermands facts to the contrary. I came across an excellent piece in the Boston Globe the other day. The subject was politics, but the principle applies more broadly.
In reality, we often base our opinions on our beliefs, which can have an uneasy relationship with facts. And rather than facts driving beliefs, our beliefs can dictate the facts we chose to accept. They can cause us to twist facts so they fit better with our preconceived notions. Worst of all, they can lead us to uncritically accept bad information just because it reinforces our beliefs. This reinforcement makes us more confident we�re right, and even less likely to listen to any new information.
In the case of drugs and medicine I can fill this post with an array of facts and if the reader is firmly persuaded ("believes") to the contrary, I will be wasting my time.
Consider these two commentaries by Naomi Freundlich.
Children have become the new growth industry for prescription drug makers. A study released last month by the pharmacy benefit manager Medco found that 26% of kids under 19�almost 30% of those aged 10 to 19�are now taking prescription medications for a chronic condition. Meanwhile, spending on prescription drugs for children increased by almost 11% last year, the largest increase experienced by all segments of the market, including the elderly. Although asthma drugs are the still the most commonly prescribed therapeutics, kids are increasingly being prescribed drugs that are decidedly uncommon for such young patients: atypical anti-psychotics, diabetes drugs, anti-hypertensives, cholesterol medications and heartburn drugs�expensive therapeutics that in the past were rarely used outside of adult populations.
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Here�s something that frankly, disturbed me. My daughter, who just finished her freshman year in college, recently told me, �I can�t believe how many kids at school take prescription drugs on a regular basis. They take Adderall to help them study, Ambien to get to sleep and Xanax to calm down.� It surprised me that at 18 she even knew all the names of these drugs. Had she said that her fellow students were using marijuana or even ecstasy I wouldn�t have been as shocked. Those are the kinds of drugs you expect to find--along with copious amounts of alcohol--on college campuses.
But this sounded like prescription pills were freely available�prescribed to students with attention-deficit diagnoses or some other mental health problem, (or swiped from parent�s medicine cabinet or obtained on-line) and then traded around like loose cigarettes at a frat party.
Together these two articles document a social problem as toxic as any conditions the drugs in question purport to relieve.
The reader is invited to follow the links for an arresting pile of disturbing information.
Our researcher Kat supplied this last story which is the reason for this post. In the same way that civilization is polluting the world's oceans with garbage, dead zones and other catastrophic consequences from fertilizer draining into rivers that feed the oceans, our drug habits are also having unintended consequences as the drugs get carried into nature via the sewers.
It sounds a tad fishy but shrimps are becoming hooked on Prozac, scientists believe.
They fear the 'happy pills' are tinkering with the creatures' brain chemistry, making them more vulnerable to being eaten by other fish and birds.
The Portsmouth University researchers looked at the effect of the anti-depressant fluoxetine, also known as Prozac, on the behaviour of shrimps.
The shrimps are widely found in British coastal waters, close to treatment plants where the water may be contaminated with Prozac.
The researchers found that the crustaceans, which are usually happiest when hiding under rocks or clumps of seaweed, were drawn out into the open.
It is thought that just as in people, Prozac is altering levels of the brain chemical serotonin.
But, while in people this lifts mood, in shrimps, it draws them towards light - and into harm's way.
Marine zoologist Alex Ford said: 'Crustaceans are crucial to the food chain and if shrimps' natural behaviour is changed because of anti-depressant levels in the sea this could seriously affect the natural balance of the eco-system.'
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Previous studies have shown that caffeine is released into our waterways after surviving the sewage treatment process. The hormones from the contraceptive Pill and HRT have been blamed for feminising fish, leading to male fish producing eggs.
The effects of antibiotics, blood pressure drugs and cholesterol-lowering drugs are also being studied around the world.
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