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What are the costs of medical errors in the United States?

By Devin G. Bost

Feb. 17, 1014

Introduction

The estimated cost of medical errors in the United States reached $17.1 billion in 2008 (Van Den Bos, Rustagi, Gray, Ziemkiewicz, & Shreve, 2011). In 1997, an estimated cost of medication-related errors in U.S. nursing homes alone reached $7.6 billion (Desai, Williams, Greene, Pierson, & Hansen, 2011). Finding ways to leverage information technology to solve the problems related to medication prescribing mistakes presents an economic tragedy, as well as a serious opportunity for both members of the public and private sectors.

How do we reduce medical errors?

Although scientists have gained a reasonable understanding of the relationships between novel drugs and the receptor sites they bind to, a significantly overlooked complication to these models results from reactions undergone by metabolites of the given drug. In other words, scientists often don’t really know what interactions are occurring between the metabolites of various combinations of drugs. This lack of awareness is only exasperated in patients with complicated disease states (e.g. diabetes) and complex multi-drug regimens that evolve over time. Luckily, modern technology is changing the way we see these problems, particularly as genomic data is becoming more widely available.

What are the industry trends?

Thanks to the human genome project, interest in genomic data is gaining momentum. As more data becomes available, more researchers are opening up access to their data to allow further collaborative research. Databases form the cornerstone of this research. Unfortunately, without common naming conventions or internal references to well-known database schemas, significant variability occurs in the data from one database to another. SQL join operations require data elements to match exactly, so enforcing relationships between databases introduces new integration challenges to the developer. Regarding what is commonly referred to as “big data,” technologies such as Hadoop have emerged for handling large volumes of unstructured data in a high-performance manner. Unfortunately for us, integrating genomic data to perform computational analysis requires data to be structured and relationships to be enforced. Luckily, drugs, for example, can be joined on CAS number, a universally recognized unique identifier, and large ontologies have emerged to join diagnostic terminology to disease states and various forms of adverse events. Other data entities can be joined to the data from PubChem and other popular databases.

What’s the value of predicting drug interactions?

Assuming that the relationships can be enforced and the data can be properly integrated, the developer now faces the serious question: “How do we computational model, simulate, and predict the net effects of drug interactions?” Such a model would allow clinical decision makers to choose medicines in a much more deterministic manner. For example, in theory, a physician could utilize such software to choose analogues of a particular drug to avert drug interactions that would otherwise be caused by a drug for which no analogues currently exist. Such software would also allow physicians to determine when particular drug combinations would be too dangerous to try on patients with complicated medical histories or disease for which cures have not yet been discovered.

References

Desai, R., Williams, C. E., Greene, S. B., Pierson, S., & Hansen, R. A. (2011). Medication errors during patient transitions into nursing homes: characteristics and association with patient harm. The American journal of geriatric pharmacotherapy, 9(6), 413-422.

Van Den Bos, J., Rustagi, K., Gray, T. H., Ziemkiewicz, E., & Shreve, J. (2011). The $17.1 billion problem: the annual cost of measurable medical errors. Health Affairs, 30(4), 596-603.

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The emergent state of drug development:

Synthetic biology in the 21st century

Drug development is emerging with a new twist. One of the greatest discoveries of the human genome project was the discovery that our genome changes – not just at conception. If someone were to sample my DNA today and again in one year, scientists recently discovered that my genetics would look totally different.

Due to this discovery, scientists have been racing to develop and reduce the costs of DNA sequencers. The pricing function of these devices resembles the pricing of computers in the early 1980’s, when computers were the size of a small room and cost more than $500,000 to own. Today, less than 40 years later, computers are the size of your palm and cost only hundreds of dollars.

The best thing, however, that this new genetic revolution has introduced is the onset of “big data.” More specifically, this emergent paradigm shift has introduced large, muti-national collaborative efforts to collect, store, and share insights into this massive wave of genetic information. As insights emerge, further data emerges. As data emerges, discoveries occur. Those discoveries result in further funding, some from governments, but mostly from philanthropists, charities, and private research organizations. Educational institutions also have a vested interest in preparing and providing additional data to assist in this collaborative effort.

Examples include:

  • Ensembl
  • Genbank
  • Drugbank.ca
  • Blast
  • ChEMBL
  • PharmGKB
  • PubChem
  • BindingDB

 

Thankfully, this data is available for development of novel applications. For my purposes, I wish to discover ways of computing drug interactions. These interactions can be predicted by evaluating enzyme interactions, drug metabolism, binding site interactions, and associated properties with those binding sites (e.g. PKI/binding affinity, diffusion coefficients, etc.). Thus, we can obtain a deterministic, differential model for computing the net effects of complex drug interactions in patients taking multiple medications. This will help providers determine whether or not it is safe to prescribe a particular medication for a patient with complicated medical histories. It will also help providers prevent dangerous adverse events by helping them determine when a particular drug may result in a “tipping point” from insignificantly contributing to an adverse event to putting the patient into danger. As data emerges, we will see the paradigm shift away from typical drug discovery toward a protein and enzyme driven approach. I will share more on this later.

Transforming medicine, one individual at a time

Devin Bost

Jan. 19,  2014

I have included a message that I sent to the attorney general regarding the Oregon Medical Board. One of the things I’ve learned about business from my class at BYU-I is that change starts with us. We must take the initiative to start change. Nobody else can we expect to implement change for us. We must start today. And so, I have begun initiating the process of establishing reform for the Oregon Medical Board. My feeling is that physician advocacy needs to transform the practice of medicine entirely.  The first way for us to change the medical board is to bring to light the anti-trust problems and the corruptions that are tearing the practice of medicine apart. There is a reason that I left the study of medicine to become a software engineer: The practice of medicine is collapsing, and until we hold the appropriate individuals responsible for destroying this field, never will we see the light at the end of the tunnel. Justice cannot rob mercy.

———————————————————————————————————————
Ellen Rosenblum

Office of the Attorney General, Oregon Department of Justice

1162 Court Street NE

Salem, OR 97301

Cc: Alan Bates

Cc: Elizabeth Steiner-Hayward

Cc: Jeff Merkley

15 Jan 2014

Request for Production of Publicly Held Documents

By the authority of ORS 192.420, pursuant to ORS 192.470, I, Devin G. Bost (the undersigned, request the Attorney General (or District Attorney of Multnomah County) to order the Oregon Medical Board (OMB) (or Health Professionals Program) and its employees to (make available for inspection) (produce a copy or copies of) the following records:

  1. The audio transcript of the public session of the Oregon Medical Board meeting dated 1/10/2014.
  2. Any documents containing allegations or investigative materials wherein my name, or any information pertaining to myself, was used, referenced, referred to, alleged, stated as fact, cited, or used in any other way, shape, or form. When considering whether or not this information is subject to disclosure, remember that I am not a licensee; nor will I ever desire to become a licensee of this board; therefore, any information involving myself, in consideration of the statements herein (section 5 of this request for information), should be subject to disclosure.
  3. A list of the following chronological entries from 1/1/2007 to-date of:

a.       OMB disciplinary licensee substance abuse evaluation, screening, treatment, pre-approval(s), and/or other forms of referral(s), such that an entry must contain (as a minimum):

i.      The name of the facility, business, individual, or legal entity to whom the licensee was directly or indirectly referred to;

ii.      The date(s) of the referral(s) and/or OMB pre-approval(s);

iii.      The number(s) of the licensee(s) whom the Board mandated such evaluation, screening, treatment, pre-approval(s), and/or other forms of referral(s); including, but not limited to, formal, informal, voluntary, and/or other forms of Board action or discipline that required the involvement of any third party;

iv. The name of the state in which the specified facility is located, as well as the address (if available) of the specified entity.

b.      To the extent that the information requested heretofore is considered conditionally exempt from disclosure under ORS 192.501, the exempt portions shall be substituted with a “condensation from the record of the significant facts that are not otherwise exempt from disclosure,” pursuant to ORS 192.423. Furthermore, if any sub-section(s) of this request are unlawful to disclose, the remaining sub-sections of this request that are not subject to exemption from disclosure shall remain in full force of law.

4.       To the extent that the individual records from sub-section 1(a)(b) of this document fail to meet the burden of what is safe to disclose as public information, please provide the requested information in an aggregated (i.e. condensed) form, pursuant to ORS 192.423, such as the following:

a.       A data table, spreadsheet, or grid-view containing these columns:

i.      The date of the action;

ii.      A non-identifiable unique numerical ID (i.e. integer-valued primary key) to represent the physician involved in the licensee action (if available) without disclosing personally-identifiable information;

iii.      The legal name of the entity to where or whom the licensee was referred, by any effect or form;

iv. The address of the entity to where or whom the licensee was referred.

5. On the condition that one or more sub-section(s) of this request, if any, shall be denied, any and all such denials shall invoke (upon the agency involved in the denial) the burden of sustaining such action in accordance with the requirements of ORS 192.450, such that the burden of any such denial(s) must outweigh the following reasons for this public records request:

i. The requester has evidence in support of concerns that specific forms of unlawfully anticompetitive behavior is occurring, with or without the knowledge of some or all of the members of the Oregon Medical Board;

ii. The specified anticompetitive activity is presenting a threat to the safety and pursuit of justice of the members of the State of Oregon;

iii. The requester has credible evidence that reveals the knowledge of the specified anticompetitive activity has been intentionally withheld from members of the Oregon Medical Board;

iv. The requester has further evidence indicating that members of the Oregon Medical Board have been presented information that was willfully and deliberately manufactured, under penalty of perjury, for the purpose of misleading members of the medical board, deceiving state officials, and suppressing discovery of the criminality of the specified misconduct;

v. The requester has information suggesting that the specified attempts to defraud the Oregon Medical Board may involve conspiracy between the specified individual(s) and specific organizations that have conducted business with the Oregon Medical Board;

vi. The requester has reason to believe that the specified organizations may be aggravated to conceal information of the specified fraudulent actions in an attempt to conceal illicit financial incentives;

vii. The requester has reason to believe that one or more members of the Oregon Medical Board may have unknowingly participated in the specified illegal misconduct without fully realizing the false pretenses under which the particular activity was instantiated;

viii. The requester has concern that the individuals involved in the specified misconduct may attempt to subvert the judicial process by impeding the release of information containing evidence that will assist in the discovery, arrest, and conviction of the specified individuals for the specified offenses;

ix. The requester has reason to believe that one or more of the individuals involved may have exploited their position(s) to gain access to controlled substances for illicit commercial purposes;

x. The requester testifies that the heretofore specified truths are endangering the Oregon Medical Board’s ability to safely regulate the practice of medicine;

xi. The requester has credible information that reveals that some of the heretofore specified tampered evidence has transgressed into civil proceedings, in direct violation of ORS 676.175 (7).

xii. The requester’s information suggests that one or more member(s) of, or affiliates with, the Oregon Medical Board have knowingly engaged in public disclosure of tampered information;

xiii. The requester’s information reveals that in at least one instance, whereof one or more member(s) of the Oregon Medical Board knowingly or unknowingly participating in the alleged criminal misconduct, members of the Oregon Medical Board were caused to depend upon information that originated from a bribed witness;

xiv. Therefore, I, Devin G. Bost, respectfully request that this request be swiftly answered in the pursuit of liberty and justice for the citizens of the State of Oregon, in consideration of the following:

  1. The information requested heretofore is useful for demonstrating the efforts by the Oregon Medical Board and Health Professionals Program to the legislature for improving the transparency of the State of Oregon and the Oregon Medical Board.
  2. In the event that a fee must be established for the purposes of answering this request, it is hereby requested that notification be provided if the fees shall be expected to exceed the cost of ten thousand US dollars ($10,000). The undersigned individual agrees to pay for the requested documents. However, to the extent that the Attorney General agrees with the public value of disclosing the requested information, I respectfully request consideration for fee reduction or waiver under ORS 192.440(5).
  3. I am requesting consideration of the fact that much of the information requested herein is not exempt from the disclosure requirements of ORS 192.501, ORS 192.502, ORS 192.493, ORS 192.596, or related subsections of the Oregon Revised Statutes when presented in the numerically condensed format as described in section 2 (of this document). Due to the implications of the allegations involved, individuals assigned to fulfill this request need to be aware that failure to disclose the requested information may be subject to the enforcement provisions of ORS 192.680 and 192.685.

Sincerely,

Devin G. Bost