Today's News and Commentary

NY Times reporter Robert Pear was an insightful investigator and commentator about health issues.
His death was announced in a number of outlets but, fittingly, here is what the NY Times had to say:
Robert Pear, Authoritative Times Reporter on Health Care, Dies at 69

About the public’s health

Juul’s ‘switch’ campaign for smokers draws new scrutiny: Vaping company Juul has been under attack for marketing to teenagers. In a strategic shift, it is now encouraging current cigarette smokers to switch to its product.

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It’s time to stop murder by counterfeit medicine: This article reviews a very serious global problem- counterfeit medication. WHO estimates that about 10% of medications world-wide are fake. Other estimates put the figure in some countries at 50%. As some in this country are promoting importation from abroad to lower our pharma costs, we should keep this problem in mind.

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Inactivated polio vaccine now introduced worldwide: This article is really an announcement. With the addition of Zimbabwe and Mongolia, every country has and endorses this polio vaccine. The problem now is getting it to all those who need it and preventing violence against those who administer it.

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Is Conference Room Air Making You Dumber?: Finally, some scientific evidence that those long meetings will not help make better decisions. As the meeting goes on and on, the accumulated carbon dioxide in the room reduces decision-making capabilities. I suppose you could open the windows, but it would be better to be more efficient in the first place.

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Coca-Cola gained control over health research in return for funding, health journal says:According to this report in Politico: “"Using Freedom of Information Act requests, researchers at the University of Cambridge identified more than 87,000 pages of documents that included five agreements between Coca-Cola and universities in the U.S. and Canada. The provisions gave Coca-Cola the right to review research in advance of the publications. It also was allowed to have control over data and disclosure of any study results.

The universities involved were Louisiana State University, University of South Carolina, University of Toronto and University of Washington.

Despite having the power to prevent publication, the researchers of the study didn’t find any hard evidence Coca-Cola exercised that right. However, the FOIA documents collected included several redactions, making a final conclusion difficult.” Do you still wonder how proposals for taxes on sugar drinks are defeated?

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Read the original research

Increase in Hepatitis A Virus Infections — United States, 2013–2018: With all the recent focus on measles, we often forget that other preventable viral infections are also on the rise. This article from the CDC calls on greater attention to immunizations for vulnerable populations.

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About pharma

Pharma companies, PBMs play blame game over drug prices at hearing: The arguing continues as Congressional committees try to get to the bottom of why drug prices are so high. At the House Energy and Commerce Committee’s Subcommittee on Health, PBMs claimed that eliminating rebates would raise premiums for individuals while drug companies said it would help them lower their prices. The article is a nice update on this ongoing issue.

Read the story or
Watch the testimony (WARNING- it’s more than 6 hours)

Most European Academic Centers Fail to Report Trials, Study Finds:The reason this story is important US news is that our regulators are considering accepting European studies for drug approvals here. If many trials are not reported, it raises concerns about that proposal.

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Medicine Use and Spending in the U.S.: This study from IQVIA found: “Spending on all U.S. medicines increased 4.5% to $344 billion on a net price basis, despite lower price growth, due to higher patient use of new and protected brands…There were 5.8 billion prescriptions dispensed in 2018, up 2.7% from 2017 when adjusted for prescription duration. More than two-thirds of total prescriptions last year were for chronic conditions, which are increasingly filled with 90-day prescriptions…”

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Drugmakers Urge FDA to Add PBPK Modeling to Food Effects Guidance:”Leading drugmakers are calling on the FDA to include the use of physiologically-based pharmacokinetic (PBPK) modeling in its draft guidance on assessing the effects of food on drugs...” The reason this story is “news” is that rules are usually imposed on industries, not originated with requests from those being regulated.

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About health insurance

Democrats launch health-care law rescue in face of Trump’s threat of repeal: Yesterday the House Democrats passed a bill that would block HHS state waivers for insurance plans meant to skirt the ACA’s regulations.

Read the story (Washington Post but appears to be open access)

About quality

Restrictive strategy versus usual care for cholecystectomy in patients with gallstones and abdominal pain (SECURE): a multicentre, randomised, parallel-arm, non-inferiority trial: This article highlights that we need to constantly reevaluate the evidence about accepted treatments. The research looks at a well-established procedure (gall bladder removal) and compares usual care with surgery only after certain more restricted criteria are used. While the clinical outcomes were the same in both groups, the latter had many fewer operations.

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About healthcare IT

2019 Data Breach Investigations Report (DBIR): Verizon just published its annual report on data breaches by industry. For healthcare, the main threat was from internal sources. However: “This is the second straight year that ransomware incidents were over 70 percent of all malware outbreaks” in this sector.

Read the report (Healthcare starts on page 44)

To Philips, the future means selling more than a better MRI machine: It might seem strange that this story is listed under IT. Phillips has announced its intention to expand from just a medical equipment company into artificial intelligence to integrate care across a continuum of services. According to its CEO, Jeroen Tas: “The whole theme around precision diagnosis is no longer about building the best MRI or CT scanner—it’s really about fusing the information you get from these modalities, and creating profiles or models of the disease that allows for a very precise selection of the right-fit therapy.”

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About health insurance

Prices Paid to Hospitals by Private Health Plans Are High Relative to Medicare and Vary Widely: This research from RAND was reported in many news outlets today. Among its findings:

“On average, case mix–adjusted hospital prices were 241 percent of Medicare prices in 2017…Relative prices for hospital outpatient services were 293 percent of Medicare rates on average…”

“Reducing hospital prices to Medicare rates over the 2015–2017 period would have reduced health care spending by approximately $7.7 billion for the employers included in this study.”

It is common knowledge that private insurance payments subsidize public programs. This study provides the amount of that subsidy. and also how much hospitals would lose if Medicare for All is implemented and adopts Medicare payment methods.

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