Today's News and Commentary

About pharma

Amgen Announces New Four-Year Outcomes Study To Examine Long-Term Effects Of Repatha (evolocumab) In High-Risk Cardiovascular Disease (CVD) Patients Without Prior Heart Attack Or Stroke: Repatha is in the newest class of cholesterol lowering drugs. It is also, by far, the most expensive class. In addition to cost, longer term effects are not known. This study will look at patients who receive this drug for at least four years. This research is very much needed to more accurately assess the cost benefit of this medication.

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Amgen and Jay Leno Partner to Sound the Alarm on High Cholesterol and its Link to Heart Attack and Stroke in Patients Most at Risk: In a related story, Amgen chose Jay Leno to promote its cholesterol lowering campaign.

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About the public’s health

Exclusive: India's health ministry calls for blocking Juul's entry into country - document: Reuters obtained a copy of a letter from India’s health ministry to the prime minister with the recommendation that Juul not be allowed into the country. The company was planning to set up a subsidiary there later this year. India has a significant prevalence of tobacco-related illnesses. Finally some government is taking real steps to help.

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Daily low-dose aspirin no longer recommended as heart attack preventative for older adults:Recent research shows that older, healthy people do not benefit from taking low dose aspirin. This weekend, these findings were incorporated into recommendations by the American College of Cardiology and American Heart Association at their annual meeting. By the way, the preferred American term is preventive not preventative.

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Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018: Much of what happens in medicine is experience-based only- meaning that good clinical studies have not been done to support treatments. Notwithstanding the previous article, this study reviewed evidence-based recommendations in cardiology. It’s conclusion is that:
“In this systematic review of 51 current guideline documents that included 6329 recommendations, 8.5% of recommendations in ACC/AHA [American College of Cardiology/American Heart Association] and 14.3% of recommendations in ESC [European Society of Cardiology]   were classified as level of evidence A (supported by evidence from multiple RCTs), compared with 11.5% of recommendations in a systematic review of ACC/AHA guidelines conducted in 2009.”

In other words, more recommendations with fewer being evidence-based.

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Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality: Another controversy is about whether eggs are bad for you. Older recommendations warned against egg consumption because of the cholesterol. Then recommendations said eggs were OK. Now this study appears to swing the pendulum back. The associations between egg consumption and cardiovascular and all-cause mortality were found to be monotonic- that is, the higher the consumption, the higher the mortality rates. The effect appears to be due to cholesterol consumption. Those who like egg whites need not worry.

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Read the NY Times article about the research

Age, Period, and Cohort Trends in Mood Disorder Indicators and Suicide- Related Outcomes in a Nationally Representative Dataset, 2005–2017:Tell your kids to get off their phones, take a break from social media and get more sleep. This research concluded that: “Cultural trends contributing to an increase in mood disorders and suicidal thoughts and behaviors since the mid-2000s, including the rise of electronic communication and digital media and declines in sleep duration, may have had a larger impact on younger people…”

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Read the general interest story on this topic

Twenty-Year Trends in Outcomes for Older Adults With Acute Myocardial Infarction in the United States: Now some good news. From 1995-2014, hospitalizations for heart attacks dropped 38% and 30 day mortality after the attack was reduced by more than a third to 12 %- an all-time low.

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About healthcare IT

Death By 1,000 Clicks: Where Electronic Health Records Went Wrong: READ THIS ARTICLE! It is a great summary of the problems with EHRs- some of which have been life-threatening or fatal. Most of the big players are mentioned as being part of the problem.

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Electronic Health Record Adoption and Nurse Reports of Usability and Quality of Care: The Role of Work Environment: As the authors point out, little is known about how the work environment affects perceptions of usability of IT systems. In short, they found that: “…independent of EHR adoption level—the hospital work environment plays a significant role in how nurses evaluate EHR usability and whether EHRs have their intended effects on improving quality and safety of care.” How the IT implementation process is carried out is undoubtedly due to management practices and the work environment it creates. One wonders, for example, if processes were improved before IT “solutions” were installed.

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About insurance

“Direct Enrollment” in Marketplace Coverage Lacks Protections for Consumers, Exposes Them to Harm: Online enrollment in an ACA exchange plan can help people find out the federally compliant coverage which might benefit them the most. Late last year the federal government allowed individuals to directly enroll in plans without ever accessing the federal marketplace. This article explains the problems that have and can occur with this new enrollment mechanism.

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Agency: 13K didn’t meet Arkansas’ Medicaid work requirement: Last month 13,000 Arkansas Medicaid beneficiaries lost coverage because they did not meet work requirements; an additional 6400 are expected to be added to that total by next month. In the meantime Ohio is going ahead with work requirements. As previously reported, the next step will be up to the courts to decide if federal waivers that allow work requirements are legal according to Medicaid law.

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Improving the Structure of Disproportionate Share Hospital [DSH] Allotment Reductions: The federal government has been planning across the board reductions in their subsidies to hospitals that serve disproportionately large Medicaid and uninsured populations. Instead of this indiscriminate approach, MedPAC is recommending that the reductions: are phased in more gradually over a longer period of time; apply first to places with unspent funding; and, are distributed “in a way that gradually improves the relationship between DSH allotments and the number of non-elderly, low-income individuals in a state.”

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MedPAC Releases Report to Congress on Medicare Payment Policy: Separately, MedPAC issued this press release summarizing payment recommendations for the coming year. It covers a wide range of programs so is hard to succinctly summarize. However, the most radical recommendation is consolidation of the The Hospital Inpatient Quality Reporting Program (IQRP), the Hospital Readmissions Reduction Program (HRRP), the Hospital-Acquired Condition Reduction Program (HACRP), and the Hospital Value-Based Purchasing (VBP) Program into one quality program based on methodology the Commission developed last year- called the he hospital value incentive program, or HVIP.

Read the press release