Busy Nurse's Station In Modern Hospital

Violence Against Health Care Workers: Legislative Responses

By Stephen Wood

COVID-19 and other diseases aren’t the only threat to health care workers. Violence in the workplace is a common occurrence and on the rise.

Despite these troubling trends, the policy response at both federal and state levels has, so far, been lacking.

In a recent survey of nurses, 59% reported that they had been the victims of workplace violence. More than half of those respondents went on to report that they were not satisfied with how the incidents were handled.

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empty hospital bed

COVID-19 Underscores Racial Disparity in Advance Directives

Cross-posted from The Hastings Center Bioethics Forum, where it originally appeared on May 26, 2020. 

By Stephen P. Wood

During a recent shift, I was the primary provider for a man in his 70s who was brought in by ambulance with respiratory failure. He had been sick for two days with a fever and a cough, weak and short of breath. The chest x-ray performed at his bedside revealed the diffuse, fluffy markings that are familiar signs of pneumonitis from COVID-19.

After giving him oxygen to improve his breathing, treating his fever, and running tests that are standard for COVID-19 patients, I clicked the admission button to cue him up for a bed. My patient and I then discussed goals of care and had a frank discussion about advance directives. He did not have an advance directive, but he knew he did not want to be resuscitated. He did not want to be put on a ventilator, go on dialysis, or receive artificial nutrition. He was quite clear and did not hesitate about these decisions. We signed the advance directive and filed it away in his chart.

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a crowd of people shuffling through a sidewalk

Lost in the Shuffle: The Impact of COVID-19 on Immigrants in Need

The recommendations for healthy people who have symptoms consistent with COVID-19, the illness caused by the corona virus called SARS-Co-V2, is to stay at home, get plenty of rest, drink fluids and control fever and body-aches with a non-steroidal medication. For people with pre-existing medical conditions, the elderly or those with more serious symptoms, an evaluation by a healthcare provider is warranted. This is a reasonable recommendation given that for most healthy people, the symptoms are uncomfortable but not life-threatening. There is a population however, that regardless of the severity of their illness, may stay at home and not seek medical care, even when things are serious. Fear of arrest and deportation is a real issue for undocumented immigrants and calling an ambulance or going to a hospital can put them at risk for these actions. The result is that some very sick people may not seek appropriate medical care. In addition, they may be taken care of by people that don’t have the appropriate personal protection, putting even more people at risk.

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a pill in place of a model globe

When it comes to opioids, it’s all about turf.

By Stephen Wood

When it comes to selling opioids, turf matters. Access to customers and geography play a role in the day to day sales of opioids. This often means selling in areas where there is a wanting and willing customer base with funds to spare. It also means picking a spot, a corner, where enforcement is low or where corruption can overcome most legal problems. The delivery can’t be too conspicuous. It needs to be hidden from plain sight, done in the shadows or alleyways where no one is looking. It’s a craft and when done right can lead to fistfuls of cash in the hands of the distributor, the dealer.

This may sound like a street-level drug deal, but it isn’t. It’s the tactic many American pharmaceutical companies are taking in response to increased regulation on prescription opioids. Like the stealth and shadowy moves of a street-level dealer, American pharmaceutical companies have moved their turf to new, mostly naïve markets to sell their wares. They have done this to escape the federal regulations that have limited their market; a response to the opioid crisis that has seen hundreds of thousands of lives affected by substance use disorder or lost to overdose.

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Photograph of commercial fishing vessels

How Thailand’s Fishing Industry and Your Tuna Melt Are Linked to Human Trafficking

By Stephen Wood

I used to be averse to mayonnaise and I still am for its use as a condiment or in dishes like coleslaw or potato salad. My grandmother made our potato salad with oil and vinegar and lots of garlic and our coleslaw was vinegar-based too. I would tell friends that I was allergic to mayonnaise so that they wouldn’t slather it on my bologna sandwich or make me eat chicken salad. I’m not sure why this is the case; mayonnaise is made from stuff I like — eggs, salt, and vinegar — and when homemade can be really delicious. It’s just weird. But something changed that. I wanted to eat tuna. Not the blue or yellow-fin tuna that you grill as a steak or to enjoy as sushi, but canned tuna. This transition happened when I moved out of my family’s home and into an apartment. I was working and living on my own and soon realized I needed to eat on the cheap. I wasn’t used to eating on the cheap. I like lobster, escargot, flank steaks, and good wine. But I was broke and on a budget so I decided that I was going to brave it and eat canned tuna. With mayonnaise. I perfected a recipe. It has tuna, mayo, celery, onion, cumin seeds, and salt. It’s topped with shredded cheese and toasted and it is delicious. I’ve overcome my aversion to mayonnaise for this one thing, and also occasionally deviled eggs. But there is a problem.

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Medical devices in a doctor's office

What the Trade War with China Means to the Medical Industry

If you rely on a pacemaker, an implanted defibrillator, a prosthetic hip, wear contacts or need an MRI, then you should be concerned about the constant threat and imposition of tariffs on Chinese imports by the Trump Administration. Using Section 301 of the Trade Act of 1974, President Donald Trump imposed new tariffs on an array of Chinese imports based on the assertion that they were stealing United States intellectual properties. The first volley occurred in July 2018 when the administration applied tariffs of 25% to over $34 billion in Chinese imports, and then again in August 2018 when it added another $16 billion in products to the list.

In an ongoing tit-for-tat, on May 10, 2019, the United States raised tariffs from 10% to 25% on an additional $200 billion worth of Chinese goods, including many health care products, from surgical gloves to chemical reagents. While medical supplies are only a small, biopsy-sized sample of the goods that will face these tariffs, they are sure to have some impact on an already financially burdened health care delivery system here in the United States. This will result in higher prices for health care products, devices, and components that are all passed off to the consumer.

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swarm of media and tv cameras

The Hidden Cost of Misinformation: Harms from Opioid Hysteria Extend Beyond Overdose Deaths

Fentanyl is a potent opioid analgesic and has been the center of the opioid and overdose epidemic. As an illicit agent, fentanyl is often in the form of a powder, which is then either insufflated (the fancy medical term for snorting) or dissolved in water and injected intravenously. It is fifty to one-hundred times more potent than heroin, the drug it replaced as the illicit opioid of choice. It can cause significant euphoria and analgesia, which is why it is so widely used. It can also cause respiratory depression or complete respiratory arrest, the reason it can be so deadly. It is readily absorbed when insufflated or injected and the actions are almost immediate. These are the facts.

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Dictionary page zooming into the word "overdose"

Public Health Approaches to the Opioid Crisis: Overcoming Obstacles to Community-Driven Solutions

Register now for “Public Health Approaches to the Opioid Crisis: Overcoming Obstacles to Community-Driven Solutions,” a lunchtime panel on April 1. 

The opioid epidemic has hit people from all walks of life. In my duties as an acute care nurse practitioner in a busy suburban emergency department I have taken care of a lot of people who face opioid addiction, ranging from young men to elderly woman.

It is an epidemic that doesn’t discriminate. There are some people who have been hit particularly hard.

In my practice, these tend to be people with housing insecurity, job instability and who are marginalized for an array of reasons. We know that people with substance use disorder often have chronic pain or medical issues. Co-morbid trauma-related mental health issues are also very common. Efforts to reduce access to opioids has been a major component of policy and practice. This has included prescribing limits and prescription monitoring programs, with the intent that limiting access will reduce the likelihood of either initial use or ongoing substance misuse. Read More