As mentioned last week, today is the day major pharmaceutical company executives will testify before Congress about price increases. More on this event tomorrow when all the testimony has been given.
FDA Approves More Generic Drugs, but Competition Still Lags: Speaking of increase prices, this study by the Pew Charitable Trusts looked at what happened to generics after Congress passed the Generic Drug User Fee Amendments (GDUFA) in 2012. Some highlights:
More drugs were approved than before the law but the speed of approval has not increased.
“Costs generally decline most significantly once second and third generics enter the market, but versions after the third generic usually reduce prices less effectively.”
“…more than 500 brand drugs still lack competition, even though there are no patent protections or periods of exclusivity that would prevent the approval of competing generic versions.3 These “sole source” products are most at risk for price spikes.”
This study is a really good review of the generics field.
CRISPR Therapeutics and Vertex Announce Progress in Clinical Development Programs for the Investigational CRISPR/Cas9 Gene-Editing Therapy CTX001: This announcement is an important milestone: the first company-sponsored use of a CRISPR/Cas9 therapy in a clinical trial. This gene-editing technique will be used to treat patients with beta thalassemia and sickle cell disease.
Antibiotic resistance: using a cultural contexts of health approach to address a global health challenge: This monograph from the WHO presents a fascinating analysis of how addressing cultural factors is essential for attacking healthcare problems- in this case antibiotic resistance. The analysis makes the case for this approach thusly:
”Any attempt to reduce inappropriate uses of antibiotics and reduce the risks of resistance requires systematic understanding of the histories and cultures of medicine uses, structural issues surrounding health and health care, and an appreciation of cultures of risk.”
This approach can be used at the organizational as well as the societal level.
Read the monograph
French Patients Refusing Generic Drugs to Face Reduced Reimbursement:The point of including this article is that the US has lots of price control mechanisms in place, but the prices themselves are so high these measures are not making a significant impact. French President Macron has just announced a new “health transformation strategy” that will be phased in over the next few years. The purpose is to increase organizational efficiency and reduce costs. Starting next year, patients who refuse generic drugs or substitutions without a valid medical reason will have higher out-of-pocket costs for those prescriptions. This practice is, of course, not new in the US; but since 2013 in France 80 percent of brand-name drugs were substituted for generics.
A comparison of scheduling, work hours, overtime and work preferences across four cohorts of newly licensed registered nurses: This article reviews the items in the title. The study found that: ”New nurses are predominantly scheduled for 12‐hour shifts and nearly half work weekly overtime, trends that have remained relatively stable over the past ten years.” The concern is overwork leading to errors- a topic addressed by residency rules limiting physician trainees from working more than 80 hour weeks.
Hospitals' all-payer margins climb in 2017 even as Medicare margins slump: Bad news and good news from MedPAC. Average hospital margins for Medicare were negative 9.9% in 2017, the lowest in at least a decade. The good news is that aggregate all-payer margins climbed to 7.1% in 2017; by comparison, it was 6.3% in 2010. These data support the contention that private insurance is subsidizing Medicare.
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About healthcare IT
Assessing the Use of Google Translate for Spanish and Chinese Translations of Emergency Department Discharge Instructions: Hospitals need to deal with an increasing number of patients whose primary language is not English. Yet translators are not always available. How good are online translations, like Google Translate (GT)? Researchers studied “100 sets of patient instructions contained 647 sentences. Overall, 594 (92%) and 522 (81%) sentences were accurately translated into Spanish and Chinese, respectively, by GT.” Not bad. It does raise the question of accuracy for other languages. Also, how critical are the errors in the non-accurate parts of the translation?
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Catholic Health merges IT to enable use of social determinant of health data: Catholic Health has incorporated what it calls the “Total Health Roadmap” into its IT capabilities for primary care physicians. This roadmap includes “a range of physical, social and psychological issues, such as availability of food and safe housing, transportation, quality child care, access to behavioral health treatment, and more.” The purpose is to prospectively identify social determinants of health that will affect a patient’s care.