Daily Rounds: Insidious Injections; Pharmacies Beat Back Controls; Feeling Partners' Pain; The Baby Formula Ban

Steroid Shot Near Spine Gives Illness Opening (The New York Times) — "An insidious factor in these cases is that the injections could well have put the immune system at a disadvantage, by introducing a pathogen into the body along with a steroid. Steroids suppress the immune response and very probably crippled its ability to attack the fungus in many patients — sort of like the scenes in gangster movies where one thug holds the victim’s arms while another beats him up. Another possibility is that differences in the injection technique might have played a role. An epidural injection is meant to enter an area called the epidural space, near the spinal cord. The needle is not supposed to pierce the dura, one of the membranes that cover the spinal cord and brain. A needle that went too far in could have nicked the dura and let the fungus into the spinal fluid, from which it could then have easily traveled to the brain. Doctors say that meningitis cannot occur unless the dura is somehow breached."

Pharmacies Fought Controls (The Wall Street Journal) — "In 1996, David Kessler, then the commissioner of the Food and Drug Administration, warned Congress that tiny drug-compounding pharmacies would spawn a "shadow industry" of unapproved drugs that "could result in serious adverse effects, including death." Today, Dr. Kessler, who worked for Republican and Democratic administrations, seems eerily prophetic. A painkilling steroid from the New England Compounding Center has exposed as many as 14,000 patients to fungal meningitis, sickened 203 people and killed 15 people. The center has shut down, and health officials warn that the number of cases is expected to rise."

$7.5 Billion. My Sympathies (Not Running A Hospital) "The $7.5 billion in assets held by Partners is larger than the following universities in this city, combined: Boston College, Boston University, Northeastern University, Tufts University, and Wellesley College. It is more than ten times larger that of the Museum of Fine Arts and 80 times larger than that of the Museum of Science." Hospitals Ditch Formula Samples To Promote Breastfeeding (The New York Times) - "As of 2011, nearly half of about 2,600 hospitals in a survey by the Centers for Disease Control and Prevention had stopped giving formula samples to breast-feeding mothers, up from a quarter in 2007. The survey did not ask about distributing samples to non-nursing mothers. Recently, 24 hospitals in Oklahoma agreed to a ban, and Massachusetts became the second state, after Rhode Island, in which all hospitals halted free samples. In New York City, Mayor Michael R. Bloomberg started the “Latch On NYC” campaign, urging hospitals to stop giveaways and monitor formula like other medical supplies, stored in locked cabinets and accounted for when mothers have medical needs or request it; 28 of 40 hospitals have agreed."