Showing posts with label public policy. Show all posts
Showing posts with label public policy. Show all posts

Monday, November 14, 2011

Safe Medical Waste Disposal

Updated 3/2017 -- all links removed (except to my own posts) as many no longer active.

All medical offices must dispose of medical waste in a safe manner.  I closed my office at the end of September, but my last medical waste pickup is the first Friday of December.  My dear husband is going to open the office and wait for them.
How have you told patients over the years to deal with their medical waste?  Needles?  Syringes?  JP drains they pull out or that fall out before they get back for follow up? 
Last week the FDA sent out a press release announcing the launch a new website for patients and caregivers on the safe disposal of needles and other so-called “sharps” that are used at home, at work and while traveling.
…….Sharps disposal guidelines and programs vary by jurisdiction. For example, in 2008, California passed legislation banning throwing needles in household trash. Florida, New Jersey and New York have established community drop off programs at hospitals and other health care facilities. People using sharps at home or work or while traveling should check with their local trash removal services or health department to find out about disposal methods available in their area.
For the safe disposal of needles and other sharps used outside of the health care setting, the FDA recommends the following:
DO:
  • Immediately place used sharps in an FDA-cleared sharps disposal container to reduce the risk of needle-sticks, cuts or punctures from loose sharps. (A list of products and companies with FDA-cleared sharps disposal containers is available on the FDA website. Although the products on the list have received FDA clearance, all products may not be currently available on the market.)    
  • If an FDA-cleared container is not available, some associations and community guidelines recommend using a heavy-duty plastic household container as an alternative. The container should be leak-resistant, remain upright during use and have a tight fitting, puncture-resistant lid, such as a plastic laundry detergent container.
  • Keep sharps and sharps disposal containers out of reach of children and pets.
  • Call your local trash or public health department in your phone book to find out about sharps disposal programs in your area. 
  • Follow your community guidelines for getting rid of your sharps disposal container.
DO NOT:
  • Throw loose sharps into the trash.
  • Flush sharps down the toilet.
  • Put sharps in a recycling bin; they are not recyclable.
  • Try to remove, bend, break or recap sharps used by another person.
  • Attempt to remove a needle without a needle clipper device.
 
For more information:
  • Needles and Other Sharps (Safe Disposal Outside of Health Care Settings)
  • Improperly Discarded ‘Sharps’ Can Be Dangerous – Consumer Update
  • Sharps Flickr Slideshow

Wednesday, December 2, 2009

Are BPA Products Safe?

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

I love the convenience of my microwave. It is especially good for reheating leftovers like the chili I made recently. I took the chili to the office in a plastic container for lunch the next day. The question is: are the BPAs in the plastic container a health risk? Should I put my chili in a Pyrex or ceramic bowl before microwaving?
Yesterday afternoon, I participated in Better Health's very first blogger briefing. The subject was Bisphenol-A (BPA) plastic safety. The briefing included an interview with Steve Hentges, PhD., Executive Director of the Polycarbonate/BPA Global Group of the American Chemistry Council (ACC), and was moderated by Dr. Steven Novella, founder of the blog Science-Based Medicine and the new policy non-profit, The Institute For Science In Medicine.
Bisphenol-A (BPA) is a chemical widely used to produce polycarbonate, a hard plastic. More than 2 million metric tons of BPA were produced worldwide in 2003. There is an increase in demand of 6% to 10% annually. BPA can be found in a wide range of products, including baby bottles, plastic utensils, and plastic food containers. It has been the focus of some controversy over its safety, and the resulting debate reveals much about how the current system deals with such issues.
The concern is that BPA can leech from plastic containers into the food or liquid it contains, and when consumed can have negative health effects. The debate is over how to interpret existing evidence about BPA safety, which gives conflicting results. Essentially it is a debate about how to weight different kinds of evidence, and where safety thresholds should be.
The Food and Drug Administration is getting ready to look at this question of BPA safety again. The history of the FDA’s stance is as follows (dated Aug 31, 2009):
In August 2008, FDA released a draft report finding that BPA remains safe in food contact materials. On October 31, 2008, a subcommittee of FDA's science board raised questions about whether FDA's review had adequately considered the most recent scientific information available. Most recently, on June 3, 2009, FDA Commissioner Dr. Margaret A. Hamburg testified before the House Committee on Energy and Commerce's Subcommittee on Health (written testimony is available at http://www.fda.gov/NewsEvents/Testimony/ucm164186.htm).
In response to a question about BPA, Dr. Hamburg emphasized that she takes the questions that have been raised about BPA very seriously, and she stated that the FDA's new Acting Chief Scientist, Dr. Jesse Goodman, is working with FDA scientists to take a fresh look at the science of BPA. FDA intends to explain the results of this review in late summer or early fall.
In August 2009, Massachusetts joined Connecticut in taking a stance on BPA. Connecticut has banned the use of BPA from infant formula and baby food cans and jars, as well as in reusable food and beverage containers sold with the state. Massachusetts has considered the same ban, but for now has only told parents of young children to avoid using baby bottles and other food and beverage containers made with the plastic-hardening chemical bisphenol A (BPA). Massachusetts is waiting the FDA’s decision on BPA.
As of the spring of this year, six major companies have agreed to stop selling hard-plastic baby bottles which contain bisphenol-A in the United States. The companies decision was in response to growing public concern. The companies are Playtex Products Inc., Gerber, Evenflo Co., Avent America Inc., Dr. Brown and Disney First Years.
From the FDA Draft Assessment:
Exposure of adults or infants to residual BPA through uses in food additives is relatively low (i.e., no more than 11 μg/person/day for any segment of the population). Traditionally, FDA’s evaluation of chemical migrants to food from the use of food contact materials at exposures of ≤ 150 μg/person/day focuses primarily on carcinogenicity and on genetic toxicity as an indicator of carcinogenicity1, unless data are available (biological or predictive) that indicate a concern for another endpoint of toxicity at this level.
It is well documented that BPA binds to estrogen receptors (ERα and ERβ), although its affinity is orders of magnitude lower than that of endogenous estrogen2,3. In addition, several in vitro studies have indicated that BPA may also interact with other receptors, including membrane bound ER and estrogen-related receptor γ (ERR γ)4. Since the late 1990s, a large volume of research has been generated suggesting a possible ‘low’ dose effect for weakly estrogenic environmental contaminants, such as BPA. The National Toxicology Program (NTP) defines ‘low’ dose for BPA as ≤ 5 mg/kg bw/day5
While BPA may bind to estrogen receptors, its metabolites don’t. The oral route is most important in this discussion. BPA is rapidly metabolized to the monoglucuronide and cleared from the body via urinary excretion. The metabolite, monoglucuronide, is biologically inactive. BPA does not accumulate in body fat or sex organs of either male or female test animals given either 10 or 100 milligrams per kilogram body weight of bisphenol A administered by oral exposure, or intraperitoneal or subcutaneous injection.
So while scientist will continue to look at BPA and its safety, I will feel safe in using plastic water bottles. I will feel safe in storing my leftovers in plastic containers. I will feel safe in reheating my leftovers in those plastic containers.
Listen to the briefing here at Better Health.
Sources
Bisphenol A in Plastics – Should We Worry? by Steven Novella (September 17, 2008)
Bisphenol A (BPA) -- FDA
FDA DRAFT Assessment of Bisphenol A for Use in Food Contact Applications (2008)
Pharmacokinetic Studies and Bisphenol A Metabolism

Tuesday, August 11, 2009

Shout Outs

Updated 3/2017--  all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

DrRich, The Covert Rationing Blog, is this week's host of Grand Rounds. You can read it here (photo credit).  It’s the “cost containment in healthcare” edition.
Critics of the Obama health (insurance) reform plan have been formally served notice that they are under observation, ……….. So, as he embarks on this week’s edition of Grand Rounds, DrRich would like to welcome any visitors who are here on behalf of such important surveillance efforts, and hasten to tell you that DrRich is on your side. Indeed, this version of Grand Rounds is dedicated to exploring the many ways in which the proposed health (insurance) reforms will succeed in all its goals, and most especially in achieving cost containment…….


The latest edition of Change of Shift (Vol 4, No 3) is hosted by Man-Nurse Diaries who used a video game theme!   What fun!You can find the schedule and the COS archives at Emergiblog.  (photo credit)
It's August and school is looming around the corner, so kids everywhere are scrambling to waste time and do as much nothing as possible. What better way to dampen your brain activity than with video games? So here it is, your video game themed Change of Shift Vol 4 No 3: The Revenge!

H/T to  @EvidenceMatters for the link to this article:  A new superbug found in Britain is major concern: Government scientists by Rebecca Smith, Medical Editor.  The article talks about an un-intended consequence of medical tourism – the global spread of antibiotic resistant bacteria.
A new superbug that is resistant to all antibiotics has been brought into Britain by patients having surgery abroad, Government scientists said.
Doctors are urged to be vigilent for a new bug that has arriving in Britain with patients who have travelled to India and Pakistan for cosmetic surgery or organ transplants and is now circulating here.

Great show on NPR yesterday on “End Of Live Decisions And The Health Care Bill.”  You can listen to it here.
A portion of one health care bill in congress states that the cost of consultations between patients and doctors over "end-of-life" issues would be covered. The proposal has sparked fears that the bill promotes euthanasia.

Dr Rob has made his local paper, “Doctor 's humor is a hit on iTunes!"  Check out his podcast,  “House Call Doctor.” You can find the list of his podcasts here.  Enjoy!

Did you know that approximately 200 people die each year in the U.S. after being struck by lightning?  H/T to @laikas  for the link to this article: ER Doc explains how to avoid or respond to lightning strike
Prevention begins by seeking cover at the start of a storm. “Lightning seems to be concentrated at the forefront of a storm,” according to Zinzuwadia, “so there tends to be a greater risk of being hit by lightning at the beginning of a storm.”

WhiteCoat raises an interesting question in his post Charity Care Tax Exemptions. 
If exemption from federal income and/or state property taxes for non-profit hospitals is based upon providing “charity care” to their surrounding communities, how will hospitals qualify for income tax and property tax exemptions if health care coverage becomes “universal” and there is no longer a need for “charity care”? ………….

Crazy for Quilts Contest Gallery is up!  The quilt I did is #4.  
All contest quilts will be auctioned via eBay. All proceeds will support AAQ.
All auctions begin and end at 9:00 PM Eastern
On eBay search keyword "Alliance for American Quilts." Never used eBay? No problem! View a great tutorial on the eBay website.

                            
This week Dr Anonymous guest will be  The Hollums Adoption.  Come joint us.  The show starts at 9 pm EST.
Upcoming Dr. A Shows 
8/20: Dr. Rob & House Call Doctor podcast
8/27: Dr. A Show 2nd Anniversary & BlogWorldExpo
9/3 : Dr. A Show (9:30pmET)

Wednesday, October 22, 2008

Organ Donation

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active and it was easier than checking each one.

Last week my friend and fellow blogger Vijay (Scan Man) asked me for information regarding organ donation in the United States.  He was preparing a talk for a local Rotary Club to try to increase organ donation in his country.  My Oct 13th issue of the AMA News arrived a couple of days later and had an article on the same issue here – trying to increase the number of organ donations in our own country.  The article is “Other Nations, Other Answers”.  I think it is a free, open link, but in case it doesn’t here are the highlights.
The highlights:
        • In late September, 99,728 people were on the United Network for Organ Sharing waiting list.
        • One waiting patient dies every 73 minutes.  Three in four waiting patients need kidneys.
        • Iran has the world’s only legal, regulated system of kidney donor compensation.  They claim to have nearly eliminated their country’s waiting list.
        • Iran implemented its unique kidney donor compensation system in 1988, and by 1999, the wait for kidneys was eliminated, according to a study in the Nov. 1, 2006, Clinical Journal of the American Society of Nephrology. By the end of 2005, nearly 20,000 kidney transplants had been performed in Iran, with more than three-quarters of the supplied kidneys coming from unrelated living donors who were paid.
        • Iran's regulated, legal system of compensating living kidney donors aims to eliminate black market organ brokers and transplant tourists, encourage cadaveric organ donation, and give both rich and poor a chance to get a kidney. Once a potential kidney recipient -- who must be an Iranian citizen -- is identified, a screening process occurs. (reference article below explains the system)
        • Spain, by law, presumes organ donation after death unless the individual said otherwise while alive.  Their cadaveric organ procurement rate is 35% higher than ours. If the U.S. could do what Spain does with its presumed-consent law, the U.S. would net nearly 14,000 more organs a year.
        • Extreme poverty, endemic corruption and a growing demand for transplants, especially of kidneys, have allowed black market trafficking to flourish in countries such as the India, Philippines, Pakistan and South Africa. This unregulated trade is universally condemned, as there is no assurance that donors are treated well or that recipients get healthy, matching organs.
        • On the black market, donors are often paid as little as $1,000 for kidneys, which sell for nearly $40,000.
        • The American Medical Association is examining solutions to the organ shortage. The AMA favors studying presumed consent as well as compensation for families of cadaveric organ donors. The Association will lobby Congress to change the 1984 National Organ Transplant Act, which bans "valuable consideration" in exchange for donation, to allow for ethically designed trials of financial incentives.

This referenced article gives the Iran system.  Organ Sales and Moral Travails: Lessons from the Living Kidney Vendor Program in Iran, Policy Analysis No. 614, Cato Institute, March 20;  Benjamin E. Hippen, MD

Other References
"A Gift of Life Deserves Compensation: How to Increase Living Kidney Donation with Realistic Incentives," Cato Institute, Nov. 7, 2007
Do Presumed Consent Laws Raise Organ Procurement Rates?" DePaul Law Review, Winter 2005-06, in pdf
AMA meeting: Delegates seek to change law on organ donor incentives July 7
Economists' study says paying for organs would cut wait lists Jan. 28
Campaign targets TV's skewed view of organ donation Sept. 3, 2007
Prisoner organ donation proposal worrisome April 9, 2007
Kidney transplant turns doctor into activist July 17, 2006

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I am an advocate of organ donation.  My driver’s license is states that I wish to be an organ donor.  I would have no problems with doing as Spain does and making everyone a “presumed” donor.  I applaud the AMA for pushing for ethically designed trials of financial incentives.