Today's News and Commentary

About the public’s health

Planned Parenthood Refuses Federal Funds Over Abortion Restrictions: “Planned Parenthood said Monday that it would withdraw from the federal family planning program that provides birth control and other health services to poor women rather than comply with a new Trump administration rule that forbids referrals to doctors who can perform abortions. 
Planned Parenthood receives about $60 million annually through the federal program, known as Title X.”

Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: US Preventive Services Task Force Recommendation Statement: “The USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with BRCA1/2 gene mutations with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing. (B recommendation) The USPSTF recommends against routine risk assessment, genetic counseling, or genetic testing for women whose personal or family history or ancestry is not associated with potentially harmful BRCA1/2 gene mutations. (D recommendation).” See, also, the accompanying editorial.

The economic case for prevention of population vitamin D deficiency: a modelling study using data from England and Wales: Researchers at the University of Birmingham calculated that adding vitamin D to wheat flour would prevent 10 million new cases of vitamin D deficiency in England and Wales over the next 90 years. The addition was extremely cost-effective; the combination of supplementation and fortification was £9.5 per QALY gained.

Flavonoid intake is associated with lower mortality in the Danish Diet Cancer and Health Cohort: The good news is that you can lower risk for mortality by eating foods you may like. “Results from our study indicate that for total flavonoid intake, risk of all-cause and CVD mortality was lower for flavonoid consumption until intakes of approximately 500 mg/d, after which higher intakes afforded no added benefit. This threshold was higher, approximately 1000 mg/d for cancer-related mortality. That the thresholds for each of the flavonoid subclasses approximately sum to the threshold for total flavonoid intake is consistent with the idea that all are important and afford added benefit. Interestingly, these threshold levels exist well within daily dietary achievable limits: one cup of tea, one apple, one orange, 100 g of blueberries, and 100 g of broccoli would provide most of the flavonoid subclasses and over 500 mg of total flavonoids. In this population it is likely that tea, chocolate, wine, apples, and pears were the main food sources of flavonoids.”

Self-sampling for human papillomavirus (HPV) testing: a systematic review and meta-analysis: Self-testing can increase compliance. “A growing evidence base, mainly from high-income countries and with significant heterogeneity, suggests HPV self-sampling can increase cervical cancer screening uptake compared with standard of care, with a marginal effect on linkage to clinical assessment/treatment.” Note that the evidence is from high income countries. There should be a business opportunity for more self-care products.

Business Roundtable Redefines the Purpose of a Corporation to Promote ‘An Economy That Serves All Americans’: This joint statement by many of the largest US firms changes the purpose of the corporation from maximizing shareholder value to stating: “Each of our stakeholders is essential.” Consider how this change will affect healthcare organizations.

About healthcare IT

First Survey of the Strategic Health Information Exchange Collaborative (SHIEC) Shows Health Information Exchanges (HIES) Provide Critical National Infrastructure: Ninety-two percent of the U.S. population is served by America’s health information exchanges (HIEs) who are members of the Strategic Health Information Exchange Collaborative (SHIEC). [See Chapter 8 of the text for more information about this initiative.]

Interoperability: Health data-sharing is lacking inside and outside of hospitals, survey says: Despite the “good news” in the above announcement, this article is another update about the lack of interoperability among data systems. This problem was reinforced by CMS Administrator Verma.

About healthcare insurance

Democrats back off once-fervent embrace of Medicare-for-all: This article explains why, “in recent months, amid polling that shows concern among voters about ending private insurance, several of the Democratic hopefuls have shifted their positions or their tone, moderating full-throated endorsement of Medicare-for-all and adopting ideas for allowing private insurance in some form.”

About healthcare quality and safety

CMS Announces Upcoming Enhancement of Overall Hospital Quality Star Ratings:”The Hospital Compare website’s Overall Hospital Quality Star Ratings rate hospital quality on a scale from one to five stars. CMS last updated the Star Ratings in February 2019, and has full confidence in their accuracy and reliability. Yet, to ensure the Star Ratings are as helpful as possible, CMS routinely refines the methodology used to calculate them. Today’s announcement means CMS plans to next update the Star Ratings in early 2020 according to the current methodology. CMS plans proposed rulemaking in 2020 to enhance the methodology and aims to finalize these rules prior to the release of the Star Ratings in calendar year 2021.” While CMS is to be praised for keeping the measures current and accurate, changing the criteria too often does not help quality improvement or the public’s understanding of the ratings. It takes time to make improvements and several years to evaluate the statistical significance of the outcomes of those efforts.

About pharma

AbbVie prices new rheumatoid arthritis drug at $59,000 a year: Last week Abbvie announced its successor to Humira for use in arthritis. “A four-week supply of Humira, the world’s best-selling medicine, has a list price of about $5,174, amounting to more than $60,000 for a year. However, the list price is not necessarily what patients actually pay as ‘out-of-pocket’ costs vary based on the duration of the treatment and individual healthcare plans…  The newly approved treatment, Rinvoq [upadacitinib] belongs to a class of medicines known as JAK inhibitors that block inflammation-causing enzymes called Janus kinases and will be available later this month… AbbVie said it planned to offer a co-pay card that could reduce out-of-pocket costs to $5 per month for eligible, commercially-insured patients, as well as a patient support program.”