Today's News and Commentary

About culture

German Court Says a Hangover Is an Illness (NY Times- subscription may be required): In response to claims of an over-the-counter hangover treatment, a Frankfurt court ruled “that a hangover is an illness, and it is illegal in Germany to claim that foods or supplements can cure human ailments or disease.”

About the public’s health

U.S. joins 19 nations, including Saudi Arabia and Russia: ‘There is no international right to an abortion’: This announcement was part of a gathering of international leaders at the UN to discuss a number of issues, such as healthcare and climate change. “The Trump administration declared there’s no ‘international right to abortion,’… calling on other countries to join a coalition pushing the elimination of what it calls ‘ambiguous’ terms and expressions, such as sexual and reproductive health, from U.N. documents.”

Massachusetts to ban sale of all vaping products for 4 months in toughest state crackdown (Washington Post- subscription may be required): This action was taken by Republican governor Charlie Baker, who was former CEO at Partners HealthCare.

Juul says its chief executive is stepping down, accepts proposed ban on most flavored vaping products (Washington Post- subscription may be required): Juul is responding to the deaths and illnesses caused by vaping. In addition to a CEO change and acceptance of ban on flavored products (except tobacco-flavored), the company said it is “suspending all broadcast, print and digital product advertising in the United States.”

Trends in Dietary Carbohydrate, Protein, and Fat Intake and Diet Quality Among US Adults, 1999-2016: “From 1999 to 2016, US adults experienced a significant decrease in percentage of energy intake from low-quality carbohydrates and significant increases in percentage of energy intake from high-quality carbohydrates, plant protein, and polyunsaturated fat. Despite improvements in macronutrient composition and diet quality, continued high intake of low-quality carbohydrates and saturated fat remained.” Good news, but we still have a long way to go. (Also read the editorial about this research.) How can we accelerate this change?

Nutrition in medical education: a systematic review: In a related article and answer to the above question, this research found that: “nutrition is insufficiently incorporated into medical education, regardless of country, setting, or year of medical education… A modest positive effect was reported from curriculum initiatives.”

About pharma

CVS launching new pharmacy solution aimed at making it easier for patients to obtain specialty drugs: “CVS is launching a new pharmacy solution aimed at cutting down the time it takes for patients to obtain specialty drugs. The new tool is built in two parts: Specialty Expedite and Specialty Connect. The former is designed to cut down the prior authorization and onboarding process significantly with the goal of reaching a three-day process…Specialty Connect is the patient-facing element of the platform, according to CVS. It allows members to select where and how they want to receive their specialty drugs…Through the communication tool, patients are also kept up to date on needed insurance information and financial supports, CVS said. To date, patients using this prong of the solution are 17.5% more likely to refill their prescription.”

Pharmaceutical companies face steeper price cuts in China as country expands drug bulk-buying scheme nationwide: As the US looks to governmental pricing of drugs, we can look to the experience of other countries. China is expanding a negotiation program it started last December in 11 major cities. The result was an average 52% drop in prices. The “ latest round of winning bids are a further 25% lower on average.”

Sanofi Faces First State Lawsuit Over NDMA: It was bound to happen. After Sanofi announced that Zantac contained the carcinogen NDMA, a Florida man sued, claiming it caused him to get breast cancer. It is not known how long the contaminant has been in Zantac. Given propensities for malpractice awards in some jurisdictions, does it matter how long?

The Democrats shepherding Pelosi’s drug pricing bill have taken plenty of campaign cash from pharma: The headline speaks for itself. The article tells “who and how much.”

About health insurance

CMS: 2020 Medicare Advantage rates lowest since 2007 as supplemental benefits take hold: “The average monthly premium for a MA plan will be $23 in 2020, a decline from the average premium of $26.87 in 2019. Since 2017, the average monthly premium for MA plans has decreased by nearly 30%, and 2020's average premium is likely to be the lowest since 2007, CMS said in a release. The agency added that the number of plan choices per county increased from about 33 plans in 2019 to 39 plans in 2020.” Good news for seniors as these plans become much more attractive.

CMS finalizes rule on DSH [Disproportionate Share Hospital] cuts worth up to $8B annually through 2025: DSH payments supplement Medicare and Medicaid reimbursements for hospitals taking care of a “disproportionate share” of patients insured by those plans and the uninsured. “Under the rule implementing reductions under stipulations in the Affordable Care Act, DSH payments will set cuts worth $8 billion for the following five years. The cuts are set to take effect Nov. 22.” Hospitals are already vowing to fight these cutbacks.

CBO [Congressional Budget Office]: Fix backed by doctors for surprise medical bills would cost billions: ”The CBO looked at an approach that is featured in a bill from Reps. Raul Ruiz (D-Calif.) and Phil Roe (R-Tenn.), and backed by doctors, finding it would cost ‘double digit billions’ of dollars over 10 years.
In contrast, the approach used in bipartisan bills that have passed out of the House Energy and Commerce Committee and the Senate Health Committee would both save more than $20 billion over 10 years, the CBO has found.” We will see if analysis wins over financial clout.

Wiping out medical debt would be a lot harder than Bernie Sanders makes it sound (Washington Post- subscription may be required): This article is a really good, in-depth critique about why the Sander’s medical debt relief plan is logistically very difficult and may actually cost much more than he said it would.

UnitedHealth report: Connecting Medicare patients with 'high-value' docs could save billions: This report from United Health Group says that “connecting all fee-for-service Medicare patients with physicians who provide high-quality care at a lower cost could save the federal health program $20.5 billion in 2020 and $286.8 billion over the next decade.” The cost will be lower also for patients, as their out-of-pocket expenses will be lower. The study used value criteria for UnitedHealthcare’s Medicare beneficiaries. Those “who were treated 75% of the time by high-value docs had 64% fewer inpatient hospital days and 35% fewer emergency department visits—leading to 21% lower risk-adjusted spending per member per month compared to other patients.”
The report further recommends that special focus should be on primary care. “As primary care physicians see by far the largest volume of patients among the specialties in the study (about 59% of patient volume), improving cost efficiency in this area could lead to $14.5 billion in savings to Medicare in 2020 and $202.9 billion over the next decade. That’s just over 70% of the total projected savings in the study…”

About healthcare IT

Amazon launches pilot of virtual employee medical service Amazon Care: “Officials said Amazon Care provides a mobile application to allow [Seattle area] employees to access virtual and in-person healthcare services from its partner, Washington-based Oasis Medical Group P.C. Services include video care, in-app text chat with clinicians, mobile care visits and prescription delivery from a care courier. The virtual services offered Monday to Friday from 8 a.m. to 9 p.m., and Saturday and Sunday, 8 a.m. to 6 p.m.” If this program is successful it will undoubtedly be rolled out to healthcare partners Berkshire Hathaway and JP Morgan Chase.

Amazon unveils Voice Interoperability Initiative to speed adoption: Interoperability among computer systems is one of the biggest problems in healthcare IT. Attention has focused on such medical record content as data, text and images. With increasing use of Voice in healthcare software and communication, this element also needs to be interoperable.
Yesterday, Amazon announced the “Voice Interoperability Initiative, a group of some 36 companies committed to ensuring voice software made by different companies works seamlessly together.
However, notably absent were two of Amazon’s biggest rivals in voice technology: Apple and Alphabet’s Google, two companies that hold keys to a smartphone market that Amazon has yet to crack.” Looks like the inter-fighting is causing the same problems with Voice as with other healthcare IT.

About diagnostics

Exact Sciences’ Colorectal Cancer Test Gets Expanded Indication: This article is a reminder that FDA approval includes use of drugs and devices for specified age groups. As colon cancer incidence has been rising in the “under 50” population, an approved method for screening has become necessary. The FDA extended approved use for this product from over age 50 to over age 45.