‘Dumping’ by Hospitals Scrutinized
Until now, the extensive debate over patient dumping--transfer by private hospitals to public ones of people who can’t pay--has tended to focus on the shunting from one hospital to another of patients undergoing emergency treatment.
But this justifiable preoccupation with dumping of critical cases may have obscured a far less common but still medically hazardous and emotionally wrenching variation, a County-USC cancer treatment specialist contends.
Involved is the transfer of seriously ill cancer patients to public hospitals after their therapy has already begun.
Such transfers, Dr. Steven Grunberg contends, often occur at the point the cancer victim’s medical insurance runs out and the private hospital or physician has collected the last benefits. Thus, cancer victims with limited insurance may find themselves abruptly switching physicians and hospitals in the middle of treatment that itself can often be painful, unpleasant and anxiety-inducing.
In a telephone interview and in a letter to the editor in the New England Journal of Medicine last week, Grunberg said such dumped cancer patients may even arrive with notes from the transferring physicians saying: “I gave the first course of chemotherapy several weeks ago. I expect you will give the remaining five courses starting tomorrow.”
Grunberg emphasized that such dumping episodes are rare--their precise frequency has never been scientifically studied--and that he was commenting on the phenomenon as an individual, not on behalf of county health agencies. But he said the practice not only needlessly disrupts cancer therapy but worsens the already serious financial plight of public health-care facilities, because the private cancer specialist collects all available insurance early in the treatment and leaves county facilities to finish the therapy with no prospect of payment.
Doctors, Grunberg said, almost always know how long a given course of cancer chemotherapy or radiation will take, and they can easily find out what insurance benefits a patient may have. Physicians, he said, should agree to finish cancer therapy if they start it or transfer the patient before treatment.
Heart Rate Risk
A notion that there is a relationship between the rate of the heartbeat and the risk of having a heart attack or dying of heart failure is the subject of a growing medical consensus. Building on this earlier research, one of the nation’s best-known research programs has reconfirmed the heart rate-risk relationship and found it extends, in many respects, to women as well as men.
Though there are some minor variations by age and sex, it appears that healthfully slow heart rates are related to a significantly decreased risk of heart disease and sudden death, researchers from the Framingham Heart Study reported. The Massachusetts project has been tracking the health of the same 5,000 people since 1948.
Men had a somewhat more direct relationship of heart rate to underlying heart disease than women, but the overall advantage of a slower heartbeat was unquestionable, the researchers reported in the American Heart Journal.
People with resting heart rates of between 30 and 67 beats per minute--statistically normal is 72--have the lowest incidence of sudden death and death due to underlying heart problems. The highest rates are among people whose hearts beat 92 to 220 times per minute. Slower heart rates are often associated with programs of physical exercise and effective stress management.
Shirt-Tie Risks
It’s no secret to men that close-fitting shirt collars and tightly tied neckties are one of the most nettlesome--if trivial--inconveniences associated with being male. Now, however, researchers at the Cornell University College of Human Ecology say these dress habits may harm vision too.
In a study involving measurement of the tightness of shirt collars and ties and vision clarity in several groups of men, researchers found that neckties tied so tightly that they reduced the natural circumference of the neck measurably cut visual acuity for such tasks as reading.
The study, reported in the journal Human Factors, speculated that the relationship between necktie tightness and vision may be due to reduction in blood flow through the carotid arteries, which supply the brain and run up the neck fairly close to the skin. Researchers said 67% of men who were studied were wearing shirts or ties that were too tight. The tie was at fault far more often than the shirt collar.
An obvious preventive step: Unfasten the top button of your shirt and loosen the knot of your tie.
