Happy Tuesday and welcome to another edition of Investigative Roundup, gleaning some of the best investigative reporting on healthcare each week.
Baylor St. Luke's Heart-Stoppingly Low Ratings
For a hospital that bills itself as one of the top places to receive heart surgery in the country, their scores are surprisingly low. In terms of overall bypass quality, Baylor St. Luke's Medical Center joined just 17 others -- out of 600 hospitals nationwide -- in earning a dubious one-star rating from the Society of Thoracic Surgeons, reporting major complication rates of 19.3% for patients undergoing these operations.
Their failure to have high-performing scores for even the most basic heart bypasses could be an indicator of system-wide atrophy, according to the latest installment in a series by the Houston Chronicle and ProPublica.
But David Berger, MD, senior vice president and chief operating officer for Baylor St. Luke's, said those problems are in the past. "Currently we are providing safe and high-quality care, and we are continuing to improve our performance daily," he told the publications.
Purdue's Opioid Opponent Utilized Oxy's Negative Press
Earlier this summer, Kaiser Health News released Purdue Pharma's marketing plans from 1996-2002. A more in-depth look at these materials showed that even in the face of early backlash and lawsuits over the opioid crisis, Purdue blamed competitor Janssen Pharmaceuticals for exploiting the bad press on their blockbuster drug OxyContin.
March of Dimes Halts Research Funding
Thirty-seven scientists and researchers were left confused and devastated after the March of Dimes Foundation pulled almost $3 million worth of research grants, according to a report in Nature. The organization maintains that its funding priorities have changed due to financial difficulties over the past few years -- an independent audit revealed that their expenses exceeded income by more than $10 million in both 2016 and 2017. The plan, the organization said, is to refocus grants away from studies on the Zika virus, Down syndrome, and other congenital disorders in order to support research on reducing pre-term births so donors can see the "significance of the work."
An Urgent Need to Stop Antibiotic Rx in Urgent Care
The battle against antibiotic resistance has a new frontline: urgent care. Wired reports on a new analysis that shows a "give the patient what they want" attitude in places where providers don't typically have long-term relationships with their patients -- ERs, urgent care, and other walk-in-style clinics. There's been a boom in urgent care clinics over the past 40 years (from a few in the 1970s to an estimated 10,000 today). The analysis of nearly 150 million outpatient visits found that 45% of urgent care center visits ended with an antibiotic prescription, compared with 24% in ERs, and just 17% and 14% in medical offices and drugstore clinics, respectively.
Many have offered solutions such as antibiotic stewardship policies and even updates to EHR software that would challenge the provider to justify their antibiotic prescription.
FDA's Fentanyl Flub
A report from the New York Times found that the FDA did nothing to prevent the off-label use of transmucosal immediate-release fentanyl. The FDA established a Risk Evaluation and Mitigation Strategy (REMS) for the powerful fentanyl formulations, which were originally approved for breakthrough pain in adult patients with cancer, but entrusted enforcement to the pharmaceutical companies manufacturing them. Despite internal reports -- obtained by Johns Hopkins researchers via a Freedom of Information Act request -- showing that the powerful and dangerous drugs were getting into the hands of patients at high risk for overdose, the agency didn't step in.
Janet Woodcock, MD, the FDA's director of the Center for Drug Evaluation and Research, told the paper that more oversight would be "extremely onerous," adding that "all drugs have risks and cause harm."
The report was released ahead of a recent FDA advisory committee meeting that addressed the subject of the REMS effectiveness for these fentanyl drugs.