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Article Artículo

As Hurricane Season Begins, Inadequate Preparation Could Lead to Another Catastrophe
Today is the official beginning of the Hurricane season in the Caribbean, and there are a number of stories from over the weekend warning of another serious catastrophe given the conditions on the ground in Haiti. As we pointed out last week, experts are forecasting an above average hurricane season, with the U.S. National Oceanic and Atmospheric Administration predicting up to 23 named tropical storms. AP reminds us that "Tropical Storm Jeanne killed nearly 3,000 people in 2004, and a series of 2008 storms killed 800 — mostly in the country's central region north of Port-au-Prince." Both the AP and the Miami Herald point out that only a very small portion of the displaced have been relocated from flood prone areas. From the AP:
Dr. Jean Pape, one of the country's most prominent public health experts, estimates that only 1 percent of the masses stuck in dangerous flood zones have been relocated.

Jake Johnston / June 01, 2010

Article Artículo

Bitter Medicine

When we become seriously ill, we put our lives in the hands of our doctors. We hope that the doctor has the knowledge to diagnose and treat our illness; and if not, will refer us to a specialist who does.But are patients getting the best standard of care, or even decent standard of care? Doctors look to treatment guidelines to guide them when making their decisions. Treatment guidelines are developed by medical associations, and they are thought to be based on the best available science.

The Infectious Diseases Society of America (IDSA) has developed treatment guidelines for a long list of infectious diseases, including Lyme disease. In their treatment guidelines for Lyme disease, the IDSA recommends very restricted treatment of 2 to 4 weeks of antibiotic therapy. Though many patients fail this treatment (treatment failure rates range from 15 to 69% in patients with neurologic Lyme disease), the IDSA recommends against additional treatment in patients who continue to be sick.

For the IDSA to make such a radical recommendation of no additional treatment for patients who fail recommended treatment, one would expect that several large clinical trials have been conducting to support it. But that is not the case. In fact, the recommendation is based on one single study by Klempner et al. (2001) that found no treatment effect in two trials they had conducted on a total of 114 patients. And the study was not even a good one. It suffered from design defects, and the statistical analysis was seriously flawed.

Patients enrolled in the study had been sick for a long time – 4.4 years on average – and had been treated with multiple rounds of antibiotics prior to entering the study. In fact more than 25 percent of the treatment group had already received more than 116 days of antibiotic treatment before the trial, including intravenous antibiotics. So the study was not, as claimed, set up to evaluate the effect of treatment in patients who failed 2-4 weeks of treatment. It is unlikely that 90 days of additional treatment administered to patients in the study would permanently cure patients who were still sick after having received an even longer period of treatment.

CEPR and Helene Jorgensen / May 27, 2010