Today's News and Commentary

About the public’s health

Binge Drinking Among Older Adults in the United States, 2015 to 2017: Binge drinking is defined as five or more drinks on the same occasion for men and four or more drinks on the same occasion for women. In this research sample of 10 927 respondents over age 65, 10.6% “were estimated to be current binge drinkers. Binge drinkers were more likely to be male, have a higher prevalence of current tobacco and/or cannabis use, and have a lower prevalence of two or more chronic diseases compared to nonbinge drinkers… the prevalence of binge drinking was higher among non‐Hispanic African Americans than whites…, tobacco users…, cannabis users …, and those who visited the ED in the past year.” The importance of this research is that the prevalence is larger than expected and interventions can be directed at certain populations.

Iceland cuts teen drinking with curfews, youth centers: At the other end of the population age group, teen drinking and drug use were huge problems in Iceland. “In 1999, when thousands of teenagers would gather in downtown Reykjavik every weekend, surveys showed 56% of Icelandic 16-year-olds drank alcohol and about as many had tried smoking. Years later, Iceland has the lowest rates for drinking and smoking among the 35 countries measured in the 2015 European School Survey Project on Alcohol and Other Drugs.” The Icelandic Centre for Social Research and Analysis accomplished this improvement by developing town-financed venues where teens can meet, instituting curfews and keeping “young people busy and parents engaged without talking much about drugs or alcohol. That stands in sharp contrast to other anti-abuse programs, which try to sway teenagers with school lectures and scary, disgusting ads showing smokers’ rotten lungs or eggs in a frying pan to represent an intoxicated brain.” The program has been successfully copied in many other countries ranging from Finland to Chile.

Association of Region and Hospital and Patient Characteristics With Use of High-Intensity Statins After Myocardial Infarction Among Medicare Beneficiaries: This research is a good example of geographic disparities in healthcare. The authors studied use of statins as secondary prevention for cardiovascular disease and found: “In models considering region and beneficiary and hospital characteristics, region was the strongest correlate of high-intensity statin use, with 66% higher use in New England than in the West South Central region.”

Whole genome sequencing revealed new molecular characteristics in multidrug resistant staphylococci recovered from high frequency touched surfaces in London: The headline speaks for itself and highlights the importance of hand handwashing.

Scientists are making human-monkey hybrids in China: “The Spanish-born biologist Juan Carlos Izpisúa Belmonte, who operates a lab at the Salk Institute in California, has been working working with monkey researchers in China to perform the disturbing research. Their objective is to create ‘human-animal chimeras,’ in this case monkey embryos to which human cells are added…The idea behind the research is to fashion animals that possess organs, like a kidney or liver, made up entirely of human cells. Such animals could be used as sources of organs for transplantation.” In addition to technical issues, a discussion of the ethics of this process is important. Additionally, will such engineered organs be allowed in this country if the process that produces them is illegal?

Performing different kinds of physical exercise differentially attenuates the genetic effects on obesity measures: Evidence from 18,424 Taiwan Biobank participants: This article is fascinating. The authors split the cause of obesity between individual behavior (overeating and sedentary) and genetically induced. Treatment of the former is straightforward. But will the same measures work on the genetic variety? The answer is a bit complex. “Regular jogging blunted the genetic effects on BMI [body mass index], BFP [body fat percentage], and HC [hip circumference]. Mountain climbing, walking, exercise walking, international standard dancing, and a longer practice of yoga also attenuated the genetic effects on BMI…Exercises such as cycling, stretching exercise, swimming, dance dance revolution, and qigong were not found to modify the genetic effects on any obesity measure.” Overall, jogging was best. One caveat: this study was done on a population of Han Chinese.

About pharma

Mylan reaches $30 million settlement in SEC's EpiPen probe: Mylan classified its branded EpiPen as a generic product so it could minimize government rebates. In 2017, the company finalized a $465 million settlement with the Justice Department. This latest, related settlement was with the SEC. I wonder how much Mylan thought it would make by misclassifying the EpiPen and if it was, a priori, worth a business risk of about half a billion dollars.

FDA drug approvals are up 11%: “The FDA accepted 137 new drug approvals (NDAs) and biologics license applications (BLAs) in 2018, up 11% from 2017 and 36% from 2012 to 2017, according to a new report. In 2017, the FDA approved 122 drugs, compared to 101 over the previous five-year period.”

GlaxoSmithKline, Pfizer complete formation of consumer healthcare joint venture: This joint venture is the latest variation on business unit restructuring in the pharma industry.

About healthcare quality/safety

Analysis of Human Performance Deficiencies Associated With Surgical Adverse Events: While perfection in any endeavor is impossible, continuing improvements require knowledge of the sources of error. Some errors are in the design of systems and require work flow or technical changes. Others are due to human error. This study found that human performance deficiencies “were identified in more than half of adverse events, most commonly associated with cognitive error in the execution of care.” Use of these findings are discussed with respect to frameworks for change.

Association of US News and World Report Top Ranking for Gastroenterology and Gastrointestinal Operation With Patient Outcomes in Abdominal Procedures: “In this administrative database study of 51 869 abdominal operations, the annual case volume was 397 at top-ranked hospitals compared with 114 at nonranked hospitals. No statistically significant differences in serious morbidity or in-hospital mortality were found between these cohorts.” This article is a comment on the volume-quality relationship. In the past it was found that hospital and/or physician volume could determine the quality of the outcome. One unstated interpretation of this research could be that physician volumes were more important than hospital volumes. Volumes per surgeon at these facilities was not studied.

About health insurance

Medicare proposes outpatient hip replacements: Medicare already pays for knee replacements on a same-day basis (that is, no hospital admission). Now it is proposing the same coverage for hip replacements. This proposal is a great opportunity to think about the financial impact on independent physicians and hospitals. Although hospitals have been moving to same-day surgeries and investments in surgicenters for years, this procedure has been mostly done as an inpatient.