Author: Eric Robertson

The tag-lines went something like this: “Watch NBC tonight and find out why the way we do CPR has changed.” So I then changed the channel, only to find the same teaser on another station. By the end of this week’s news cycle, an unassuming viewer could be convinced not to perform rescue breaths as part of CPR.

I’m sure you know what I’m talking about, a new study released this week in The Lancet, a well respected peer-reviewed journal. In observing survival rates of over 4000 individuals, it found no benefit to those receiving both breaths and compressions. In fact 22% of those without rescue breaths survived, while only 10% with rescue breaths survived. Time to jump on a single study bandwagon???

Not yet:

1. The study looked at older CPR guidelines (15:2), not the current 30 compressions to 2 breaths.
2. The study only looked at cardiac-related cardiac arrest. Non-cardiac causes of arrest include drowning, trauma, choking.
3. The study only looked at adults, who have much less sensitivity to lack of Oxygen than do children.

And this is why, despite presumably hundreds of calls from the media, The American Heart Association has decided not to change its CPR Guidelines.

News Watcher Beware!

Labels: current press, health policy

So, in my prolific web/headline surfing I have become fond of, I often find myself viewing items I wouldn’t have expected. Today, I was reading through hundreds of reader-entered Haiku poems for a contest. The poems are for, and supposed to be about, Font. Typeset. For a dictionary. The Helvetica documentary to be specific.

Most were like this (by Dan):

About mid-way down the list I found this (by Sean):

Labels: misc.

Well, I’m done with my rant for the day. A change of pace is needed. Here is a very cool new type of spinal implant to check out: http://www.impliant.com/

It’s like an existing Lumbar Disk Replacement product, but mutli-level and the website has some very trendy videos!

On a roll? Check out this professor at Yale, a disc replacement geek!

Labels: back pain, physical therapy

In the past week, I’ve noticed two different reports of instances where an individual has defrauded Medicare for millions of dollars through billing for Physical Therapy Services.

This guy in Trenton, NJ.

And this guy in Detroit.

Now, according to reports, the prevalence of this crime is growing. But what does Medicare know about opporunities for fraud within its system?

An Example: In May 2006, a report was issued by the The Department of Health and Human Services, Office of Inspector General regarding Medicare Billing for Physical Therapy by Physicians and the “incident to” rule.

Here are some excerpts from that report:

• “Physical therapy billed directly by physicians represented approximately $158 million out of a total of approximately $528 million for physical therapy claims billed to the Part B carriers and allowed by Medicare in the first 6 months of 2002. Medicare allows physicians to submit claims for physical therapy that they do not perform personally, as long as the services are an “integral, although incidental, part of the physicians’ personal professional services in the course of diagnosis or treatment of an injury or illness.”2 The total allowed for physicians’ physical therapy claims has increased from $353 million in 2002 to $509 million in 2004, and the number of physicians who billed for more than $1 million in physical therapy has more than doubled, from 15 to 38 in the same 2-year period.”

• “Under the “incident to” rule, licensed physical therapists need not perform the services, and Medicare currently does not require licensure or certification of staff that perform “incident to” physical therapy. However, in all other settings…Medicare requires that only licensed physical therapists can render physical therapy.”

• “78 percent of physical therapy rendered in physicians’ offices did not represent true physical therapy”

• “Ninety-one percent of physical therapy billed by physicians and allowed by Medicare during the first 6 months of 2002 did not meet program requirements, resulting in $136 million in improper payments.”

• “Because of inadequate documentation, reviewers had difficulty assessing the quality of the therapy services.”

• “One beneficiary in our sample received 15 months of physical therapy for lumbago and osteoarthritis, for which Medicare allowed $39,126. The beneficiary’s physician did not document a plan of care and did not establish medical necessity for the services. The physician, a general practitioner, billed physical therapy to Medicare for 672 patients in 2002, an average of 27 patients per day. In 2002, Medicare allowed $752,531 for this physician’s physical therapy claims.”

WOW!

And, the report’s conclusions and recommendations:

“…we have decided not to issue a report that would include formal recommendations to CMS. Instead, we are transmitting this summary of our review in the event that the information will be useful CMS’ s review of the physical therapy benefit and future considerations of the “incident to” rule.”

Translation: They did NOTHING!

If Medicare doesn’t act to reduce the opportunity for fraudulent billing, how can they ever expect not to have fraudulent billing. Granted, the instances in the news were not physicians, but the point of bringing up this report was to highlight the number and type of loopholes in this system that go unchecked. If you want to attract a mouse, put out some cheese!

I am glad they caught these criminals, however.

Labels: current press, health policy, physical therapy

As I was writing this post about smoking cessation and exercise for The Metro Spirit, I felt kind of cheap. The reason: I was extolling the benefits of a study “recently released.” I usually have a big problem with media reports of new studies. We know there is a problem with science literacy, and media reports often have mis-representations of the signifigance or implications of new research.

A quick search found an example of a media report entitled,

This report detailed the observation of only 32 out of the thousands of individuals who have weight loss surgery. There was no risk:benefit analyisis and the researcher even refused to comment on how common the occurence of this issue is among people treated for weight loss with surgery. The research seemed solid, but the fright-factor of the headline seems out of place.

I have decided, therefore, to pay more attention to the type of evidence I’m writing about. Type of evidence you say?

Levels of Evidence

Scientific research/evidence is broken down into levels.
Or here.

At the bottom is case reports, which are simple observations recorded objectively. Further up, there are Randomized Controlled Trials (RCTs), which are good prospective studies where one can begin to imply causality. At the top are Systematic Reviews (SR), where statistical researchers sort through only the best RCTs and hold them to high standards. The conclusions of a SR can be held in very high regard.

For what its worth, and your still reading this, the study about smoking I mentioned above was a Systematic Review. I just want everyone to know that as I do my part to advance science literacy…(and release my inner nerd energy.)

I will hereby vow from now on, to report the level of evidence in articles I’m citing when appropriate. I’ll simply tell you Good, Fair, or Less Than Solid.

Labels: Metro Spirit, Research, Science Literacy

Today’s New York Times had a great article on the Japanese “tradition” of whaling. I decided to post this as a follow-up to my previous whaling post.

My favorite quote from the article:

This is a well written piece that offers some great perspective and information on the subject. It’s helped me to understand why Japan is so insistent on the issue. I couldn’t beleive it when the article explained how the U.S. actually introduced this “tradition” to Japan!

Apparently whale meat is “strong smelling” and they need to stew it in ketchup to mask its flavor. The thing that still bothers me: Tradition or not, there is a reluctance by those favoring whaling to acknowledge these animals as highly evolved mammals, that fall a little too close to us on the evolutionary chain. Should we really eat them?

Whales, Dophins, Elephants, Gorillas, Oh my!

Labels: current press, environment

I guess I find it odd that no one looked for this before now, but some food chemists finally decided to stop assuming that fiber is only consumed via plants, and checked out my cup of coffee for fiber. They found it!

Labels: coffee

In a news release today, the American Physical Therapy Association reported that its Board of Directors had voted to create a grant program to help state chapters market the profession.

Labels: APTA, physical therapy

Labels: physical therapy

In earlier posts I have mentioned some instances where scientists have felt “limited” in their ability to speak freely about climate change. Today, a report in the Seattle Post-Intelligencer outlines another such instance. Scientists from the Fish and Wildlife Service were told on two separate occasions not to discuss the effect climate change has on polar bears. This, in reference to their upcoming meetings in Norway and Russia about polar bears. A third memo says the policy will apply for trips to those two nations as well as Canada and “any northern country.”

Labels: current press, environment