Whitney Houston death: Subpoenas likely for doctors, pharmacies

From the LA Times:

Investigators are expected to serve subpoenas on doctors and pharmacies this week as they try to determine whether prescription drugs found in Whitney Houston's hotel room had anything to do with her death, according to a source with knowledge of the case.

“Subpoena power is one of the wonderful tools an investigator uses to get information from pharmacies and doctors,” said Dave Campbell, a retired captain from the coroner’s office. “You’re primarily seeking documents, not the persons who treated or prescribed, because you are doing a death investigation, not a criminal investigation.”

Campbell said investigators generally concentrate on the physicians most clearly connected to any prescription drugs recovered or conditions they know about. “Your saw a lot of this in the Michael Jackson case and I’m sure it will be useful in this incidence," Campbell added, referring to death investigation focusing on prescription drugs launched after the singer died in 2009.

He added that investigators would count the tablets in each container and compare them against the date of the prescription to see if the person was taking the correct dosage. "Sometimes you find other medications inside" the bottles, he said.

Authorities collected several bottles of drugs from Houston's suite at the Beverly Hilton Hotel, where she was found dead Saturday. But officials have said the amounts of drugs did not seem unusually large, leaving it unclear whether the medications had anything to do with the singer's death. Officials are waiting for the results of toxicology tests on Houston's body.

The source would not discuss specifics of the case but said it was standard practice to examine whether the drugs were dispensed properly and if there was any indication that she was receiving too many prescriptions. The source spoke on the condition of anonymity because the case is ongoing.

Defense attorney Ellyn Garofalo, who won acquittal for a physician charged with over-prescribing drugs to Anna Nicole Smith, said investigators were probably going to be looking at several specific areas.

They will compare the amounts of prescription medications gathered from Houston's room with the amounts of medication that were dispensed. They will look at which pharmacies dispensed the drugs and which doctor or doctors prescribed them. That information could be compared against the prescribing history of one or more doctors who treated Houston.

A red flag would be a single doctor prescribing enormous amounts of medication, Garofalo said.

After Jackson died in 2009, authorities spent months looking at bags full of prescription drugs found at his home. Prosecutors charged his doctor, Conrad Murray, in connection with the star's death.

Investigators will probably also use a state-created database with more than 100 million entries for controlled substances prescribed in California. The database has been used in past cases to determine the amount of drugs patients were receiving and how much doctors were prescribing.

Online mortality calculator could change healthcare

The Daily Beast reports: When a team of researchers at University of California, San Francisco, started collecting tools for predicting the likelihood of death, they thought their work would be used primarily by physicians. But the project ended up as an interactive tool that would be of interest to medical professionals, elderly patients—and the morbidly curious alike.

The site, ePrognosis.org, displays 16 different methods for determining a person’s chances of dying in the near future. The team designed the site so that doctors could have something better to go on than average life expectancy and intuition when deciding what treatments to recommend for elderly patients. The hope is that a better understanding of life expectancy will help patients and doctors decide on treatments—for instance, sparing a patient with advanced cancer from an invasive procedure for an ailment that likely will never have the chance to become a problem.

The tools aren’t new. Many were publicly available before, or kept behind medical-journal paywalls. But this is the first time so many have been assembled in one place, ranked according to their accuracy, and made so user friendly. A doctor—or anyone who clicks a button saying she’s a doctor—can plug in the relevant medical information and get a prognosis: 59 percent chance of dying within four years for an elderly diabetic male smoker with a history of congestive heart failure, for example.

The hazards of treating loved ones

It was a busy day for the cardiologist. Between juggling patients, he received a phone call from his mother. She said she had heartburn and complained that none of the usual over-the-counter medications had helped.

So the cardiologist quickly called in a prescription for her for an acid blocker and went back to seeing patients. Later that afternoon, his mother called again -- this time from an emergency department. The doctors there said she had a heart attack.

It's a story that Humayun Chaudhry, DO, president of the Federation of State Medical Boards, told medical students during his teaching days. The cardiologist, a former colleague of Dr. Chaudhry's who was well-respected in the field, couldn't believe he had missed the diagnosis in his own mother.

Interesting story in American Medical News.

Texas readies a new weapon against 'doctor shopping'

In today's Austin American Statesman:

As prescription drug abuse increases, Texas is readying a new weapon to catch patients who "doctor shop" for multiple prescriptions and physicians who prescribe too many painkillers.

The Texas Department of Public Safety has been collecting prescription histories of Texans for years, but by this summer the data are expected to be online so doctors, pharmacists and law enforcement officials can more quickly identify the patients abusing pain medications and the medical establishments profiting from the drug trade.

The Legislature last year made "doctor shopping" a felony in most cases and has tried to curb so-called pill mills that supply popular painkillers. Next year, the Legislature will consider whether to make it mandatory for doctors and pharmacists to check the state database before writing or filling a prescription....

"Prescription drug abuse is an epidemic in our state and the nation," said Sen. Tommy Williams, R-The Woodlands, who has authored several laws addressing the issue.

He said last year were 188 overdose deaths attributed to prescription drugs in Harris County alone. He said the problem with pill mills in Texas spiked after Louisiana cracked down.

"They've run a lot of this business into Texas," Williams said.

Click here to read the full article.

Ear Doctors Performing Face-Lifts?

That's not going as far afield as some might think. As one Texas physician points out,

Most otolaryngology training includes significant facial cosmetic training, including face lifts, rhinoplasty eyes etc, probably at least as much as plastics.The tummy tuck, not so much.

Here's an excerpt from a recent New York Times story:

After moving from New York to Los Angeles in 2010 to take a job with a financial services firm, Joan, now 59, believed she needed to freshen her look. So she got a face-lift and tummy tuck from a board-certified doctor in Beverly Hills.

What she did not realize was that his certification was in otolaryngology — ear, nose and throat — not plastic surgery. The outcome was less than ideal: thick scars on her temples and a wavy abdomen.

“I had to use all my savings to get a real plastic surgeon to fix what he did to me,” said Joan, who asked that her last name be withheld to protect her privacy. “I have an M.B.A. I’m not stupid. But when the doctor has a nice clinic and all those diplomas and certifications on the wall, you think he knows what he’s doing.”

With declining insurance reimbursements, more doctors, regardless of specialty, are expanding their practices to include lucrative cosmetic procedures paid for out of pocket by patients.

You can easily check a doctor's board certification on TMB's website. On the upper left side of the homepage, click on "Look Up a Doctor." Accept the useage terms, enter the physician's name, then click on the name to reach the doctor's full profile. Scroll down to the section titled "Specialty Board Certification."

For the NYT story, click here: http://www.nytimes.com/2012/01/31/health/non-specialists-expand-into-lucrative-cosmetic-surgery-procedures.html

Tick tally reveals Lyme risk locations

For four years, researchers combed through hundreds of state parks and bushy areas looking for the culprit responsible for Lyme disease. The blacklegged tick, also known as a deer tick, transmits the disease through a bite.

About 20 percent of the 5,332 ticks collected in the Eastern half of the country were infected with the bacterium that causes Lyme disease.

Lead author Maria Diuk-Wasser says her suspicion about where her team would find infected ticks — and the subsequent risk for the disease — was confirmed when she mapped the data.

"We suspected strongly that we wouldn't find [infected ticks] in the South," the Yale epidemiologist tells Shots. "The tick is found in the South, but it's not infected and it doesn't feed on humans, but on lizards." Researchers found the highest risk of infection for humans in the Northeast, Mid-Atlantic and Upper Midwest.

Read the story on Minnesota Public Radio's website:
http://minnesota.publicradio.org/features/npr.php?id=146211699