Today's News and Commentary

About the public’s health

Can Plant-Based Meat Alternatives Be Part of a Healthy and Sustainable Diet?: This article is a really good summary of the issues regarding meat-based substitutes. One issue it does not discuss is whether ingredients are organic.

Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality: In a related article, Japanese researchers found that: “higher plant protein intake was associated with lower total and CVD-related mortality. Although animal protein intake was not associated with mortality outcomes, replacement of red meat protein or processed meat protein with plant protein was associated with lower total, cancer-related, and CVD-related mortality.”

Insurance companies continue to expand programs to address social determinants of health: Here are a couple more examples: Blue Cross Plan Doubles Housing Investments To Address Social Determinants and Cigna earmarks $5 million in grants to reduce child food insecurity.

DEA to expand marijuana research after years of delay: “The U.S. Drug Enforcement Administration said on Monday that it will move ahead with a long-delayed expansion of its marijuana research program, in a sign that the Trump administration’s hostility to the drug may be waning as a growing number of states have legalized its use.”

The Clinical Course after Long‐Term Acute Care Hospital [LTACH] Admission among Older Medicare Beneficiaries: What happens after an elderly patient is transferred to an LTACH? “Of 14 072 hospitalized older adults transferred to an LTAC hospital, median survival was 8.3 months, and 1‐ and 5‐year survival rates were 45% and 18%, respectively. Following LTAC admission, 53% never achieved a 60‐day recovery. The median time of their remaining life a patient spent as an inpatient after LTAC admission was 65.6%… More than one‐third (36.9%) died in an inpatient setting, never returning home after the LTAC admission. During the preceding hospitalization and index LTAC admission, 30.9% received an artificial life‐prolonging procedure, and 1% had a palliative care physician consultation.” As the authors points out, given the very high mortality rate and very low palliative care referrals, we need to change the service mix provided to this population.

Effect of Different Financial Incentive Structures on Promoting Physical Activity Among Adults: Different schemes have been tried to get people to engage in healthier behavior. This randomized control study found that: " financial incentives for physical activity were more effective during a payment period when they were offered at a constant rate rather than an increasing or decreasing rate. However, this effectiveness dissipated shortly after the incentives were removed.”

About healthcare IT

Groups oppose HHS efforts to change SUD [substance use disorder]privacy rules: This article is a fascinating example of legitimate competing interests. As previously reported, the federal government is trying to ease the confidentiality requirements for transmission of behavioral health information in order to facilitate treatment of opioid- dependent patients. Now, patient-rights advocates are claiming that such relaxation may concern patients enough so that they will not seek treatment. Is there evidence for either opinion?

Americans’ views on data privacy and e-cigarettes: This survey by POLITICO and the Harvard T.H. Chan School of Public Health found that more “than half of adults say they are very concerned that unauthorized people may gain access to their Social Security number (63%) or their credit card number (57%).” Although physician offices rank highest in trust among all institutions studied, the confidence level was only 34%. By contrast, banks were 29% and social media scored 3%. What do these figures say about the public’s willingness to have a unique identifier necessary for optimal interoperability of medical information?

Risk of Wrong-Patient Orders Among Multiple vs Singleton Births in the Neonatal Intensive Care Units of 2 Integrated Health Care Systems: This problem is an IT issue. The authors concluded that: “This study suggests that multiple-birth status in the NICU is associated with significantly increased risk of wrong-patient orders compared with singleton-birth status. This excess risk appears to be owing to misidentification between siblings. These results suggest that a distinct naming convention as required by The Joint Commission may provide insufficient protection against identification errors among multiple-birth infants. Strategies to reduce this risk include using given names at birth, changing from temporary to given names when available, and encouraging parents to select names for multiple births before they are born when acceptable to families.” A simpler strategy would be to assign a unique identifier at birth.

About health insurance

Inside North Carolina’s Big Effort to Transform Health Care (NY Times, subscription may be required): This article is a good in-depth look at how one state is changing to value-based care from traditional fee-for service. What are insurance companies doing and what are the changes provider must make to comply?

About pharma

One third of pre-approved prescription drugs have not completed the FDA approval process: “The Food and Drug Administration’s (FDA) Accelerated Approval Program was created in 1992 to significantly accelerate the ability to bring certain new drugs to market. New research to be published in an upcoming issue of Manufacturing & Service Operations Management reveals a large number of drug manufacturers are failing to complete the approval process, meaning a significant number of drugs on the market are not yet fully approved.”

Don’t Give Up on Biosimilars—Congress Can Give Them a Boost: This op-ed piece in the Wall Street Journal by former FDA Commissioner Gottlieb offers some solutions to the high cost of biosimilars that will still preserve some of the free market advantages to the initial developer.

Trends in Prices, Market Share, and Spending on Self-administered Disease-Modifying Therapies for Multiple Sclerosis [MS] in Medicare Part D: The recent focus on drug costs has been on diabetes. This article is a reminder that other conditions are likewise affected: “prices of self-administered DMTs [disease modifying treatments] for MS increased dramatically between 2006 and 2016. This resulted in a 7.2-fold increase in patient out-of-pocket costs.”

The Alliance for Regenerative Medicine Releases Statement of Principles on Genome Editing: “The Alliance for Regenerative Medicine (ARM), the international advocacy organization representing the cell and gene therapy and broader regenerative medicine sector, today released a Therapeutic Developers’ Statement of Principles, setting forth a bioethical framework for the use of gene editing in therapeutic applications.” One of the stated principles is: “We assert that germline gene editing is currently inappropriate in human clinical settings.” It appears that in this field, ethics is catching up to technology.

BREAKING NEWS: Purdue Pharma offers up to $12 billion to settle opioid cases: report: According to two people familiar with the matter, Purdue Pharma and its owners are prepared to offer $10 billion to $12 billion to settle more than 2000 lawsuits accusing the company of fueling the US opioid crisis, NBC News reported.

About healthcare devices

CDRH [FDA Center for Devices and Radiological Health] Regulatory Science Priorities: The CDRH has listed its top 10 priority areas. While some are device-specific, others are of general healthcare interest, e.g., patient input, big data and computational modeling.

FDA Clears Biobeat’s Cuffless Blood Pressure Monitors: This device is a true monitoring breakthrough. Here is more information.