Today's News and Commentary

About pharma

Inside the Drug Industry’s Plan to Defeat the DEA: This in-depth investigative piece in the Washington Post exposes newly released documents revealing how some pharma companies knew about the opioid crisis for years. “The industry enlisted members of Congress to limit the powers of the Drug Enforcement Administration. It devised “tactics” to push back against the agency. And it commissioned a ‘Crisis Playbook’ to burnish its image and blame the federal government for not doing enough to stop the epidemic.” Great investigative reporting.

Zantac and some OTC meds found to contain suspected carcinogen first discovered in blood pressure drugs: Recently, the drug Valsartan was found to be contaminated with N-nitrosodimethylamine (NDMA), which, in sufficient concentrations, is carcinogenic. Now the FDA has found small amounts of the substance in Zantac and some other over-the-counter heartburn drugs. Sources of the contaminant are still not certain.

About the public’s health

U.S. Obesity Rates Reach Historic Highs – Racial, Ethnic, Gender and Geographic Discrepancies Continue to Persist: Obesity is still a huge public health problem and this study provides an in-depth look at the statistics. Of note is that:
”Obesity rates vary considerably between states with Mississippi and West Virginia having the highest level of adult obesity in the nation at 39.5 percent and Colorado having the lowest rate at 23.0 percent.

As recently as 2012, no state had an adult obesity rate over 35 percent and within the last five years (2013 and 2018) 33 states had statistically significant increases in their rates of adult obesity.”

Revealed: Public Health England 'hot on the trail' of Disease X: While the examples are from England the approach is universal: How do you approach identifying and understanding the next, new infectious agent?

The switch’ was supposed to be a major step toward eradicating polio. Now it’s a quandary: Oral polio vaccine contains different strains of live, attenuated viruses. Type 2 poliovirus was declared eradicated in 2015, so recently it was eliminated from the oral vaccine. But the residual attenuated strain from vaccines still exists. The quandary is this: Is it unethical to give new vaccinations with Type 2 poliovirus if it has been wiped out or should it still be in vaccines in case the type emerges again from those who are vaccinated. Read this fascinating article. It’s as much ethics as science.

Gluten Does Not Induce Gastrointestinal Symptoms in Healthy Volunteers: A Double-Blind Randomized Placebo Trial: The title says it all.

About health insurance

Who Are the Remaining Uninsured, and Why Do They Lack Coverage?: In answering this question, the Commonwealth foundation looked at 2018 data. The whole article is interesting, but the highlights are:

“…uninsured working-age adults in the United States were disproportionately low income, Latino, and under age 35.

Nearly half of uninsured adults may have been eligible for subsidized insurance through the marketplace or their state’s expanded Medicaid program.

Two-thirds (67%) of uninsured adults had not gone to the marketplace to examine their coverage options. Of those, one-third (36%) said they didn’t think they could afford health insurance.

Following the ACA individual market subsidies and reforms, the share of adults who had tried to buy a plan in the individual market and reported difficulties finding an affordable plan fell from 60 percent to 34 percent. In 2018, 42 percent of adults reported difficulty finding affordable coverage.

Despite affordability concerns and changes made by Congress and the Trump administration, 62 percent of adults with individual coverage and 84 percent with Medicaid rated their coverage as ‘good,’ ‘very good,’ or ‘excellent.’”

Annual Spending per Patient and Quality in Hospital-Owned Versus Physician-Owned Organizations: an Observational Study: Bottom line: “We find that financial integration between physicians and hospitals raises patient spending, but not care quality.”

In largest healthcare fraud case, Florida executive sentenced to 20 years in prison: A nursing home operator was “found guilty of submitting fraudulent claims for services that were not provided, not medically necessary or were procured through the payment of kickbacks. He was convicted of 20 charges including money laundering, receiving healthcare kickbacks, bribery conspiracy and obstruction of justice.” The amount of Medicare and Medicaid fraudulent billing was put at $1.5 billion.

Where do the Democratic candidates stand on healthcare issues? Last night’s portion of the candidates’ debate on healthcare issues focused insurance and the “big 3 (Biden, Sanders, Warren) had predictable answers. Here are some summaries: CNBC; The Atlantic; NPR; and The Washington Post

A majority of physicians now take part in an ACO: According to the AMA: “Overall, 53.8% of physicians reported participation in at least one ACO type in 2018…” We still need to see if practice behavior changed as a result.

2020 Global Medical Trend Rates Report: This report from Aon concludes, among other findings, that U.S. employers' medical costs will increase 6.5% next year and global employer health benefit costs are predicted to rise by 8%. For comparison, the inflation prediction for 2020 is 3.8%.

About healthcare quality and patient safety

Nearly 1 in 6 Docs Say They Make Diagnostic Errors Every Day: “One in six physicians estimated in a Medscape poll that they make diagnostic errors every day.

That number varied by specialty. Pediatricians were less likely to say they made diagnostic errors every day (11%) and emergency medicine (EM) doctors were more likely, at 26%. In between were physicians in family medicine (18%), general practice (22%), and internal medicine (15%).

Nurses, advanced practice registered nurses, and physician assistants (PAs) answered similarly: in all three categories, 17% said they estimated they made diagnostic errors daily…

Physicians and NPs/PAs agreed on the top three reasons diagnostic errors occur: ‘lack of feedback on diagnostic accuracy’ … time constraints, [and] ‘a culture that discourages disclosure or errors…’”