Today's News and Commentary

In Memorium

Dr. Donald Lindberg, 85, Dies; Opened Medical Research to the World: Dr. Lindberg was responsible for guiding the National Library of Medicine into the modern era, making research possible for scientists all over the world.

About medical practice

Complete Revascularization with Multivessel PCI for Myocardial Infarction: When someone has an acute heart attack, a standard treatment is to immediately visualize the circulation of the heart and open the “clogged” blood vessel responsible for the problem. But often disease is found in other blood vessels. What is to be done about them? According to this Canadian study, taking care of those other blockages is better than just treating the offending one. Such a comprehensive approach results in reduced risk of death from heart disease. If results of this research influence further practice we could see more procedures at a higher short-term cost, but better outcomes.

Association of Primary Care Clinic Appointment Time With Opioid Prescribing: We know from behavioral research that time of day influences decisions, such as judges granting parole. This paper concludes that “even within an individual physician’s schedule, clinical decision-making for opioid prescribing varies by the timing and lateness of appointments.”

About the public’s health

Food insecurity adds $53 billion annually to healthcare costs. Food insecurity is more than about being hungry, it's about the estimated 1 in 8 Americans who do not have access to nutritious food: The headline is self explanatory and explains why health systems are now paying so much attention to the social determinants of health. Read the original study from the CDC.

.A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4): a cluster-randomised controlled trial: “A comprehensive model of care led by NPHWs [non-physician health workers], involving primary care physicians and family that was informed by local context, substantially improved blood pressure control and cardiovascular disease risk. This strategy is effective, pragmatic, and has the potential to substantially reduce cardiovascular disease compared with current strategies that are typically physician based.” Read the article for more details. To what other problems can this strategy apply?

New York City declares end to measles outbreak: The headline speaks for itself. This case study is a great example of overcoming prejudice to vaccination in a specific location. The epidemic is not necessarily over elsewhere. See also the CNN report.

Michigan becomes first state to ban flavored e-cigarettes: Which states will be next?

New hypertension cases halved with community-wide salt substitution: The headline is self-explanatory and you can read the article for details. This concept, however is not new. Comprehensive community-wide activities were the reason for the success of the North Karelia project in Finland starting in the early 1970s. What is taking other countries to catch on?

Feasibility of Core Antimicrobial Stewardship Interventions in Community Hospitals: What is the best way to conduct antibiotic stewardship programs? This crossover study provides some useful answers. “Two antimicrobial stewardship strategies targeted… [certain antibiotics] on formulary at the study hospitals: (1) modified preauthorization (PA), in which the prescriber had to receive pharmacist approval for continued use of the antibiotic after the first dose, and (2) postprescription audit and review (PPR), in which the pharmacist would engage the prescriber about antibiotic appropriateness after 72 hours of therapy. Two hospitals performed modified PA for 6 months, then PPR for 6 months after a 1-month washout. The other 2 hospitals performed the reverse.” Most hospitals now use the PA strategy. However, the research showed that strict “PA was not feasible in the study hospitals. In contrast, PPR was a feasible and effective strategy for antimicrobial stewardship in settings with limited resources and expertise.”

Cancer overtakes heart disease as biggest rich-world killer: For a number of years, chronic diseases have replaced acute episodes (like infections) as the #1 killer worldwide. Now we just have a trading of places for the top slot. Still, much work needs to be done on all fronts because each country “is unhappy in its own way.”

About pharma

Biomarkers (such as genetic profiles) have been used to guide treatments, particularly in oncology. One newer term for biomarkers used in this fashion is companion diagnostics.

$3K for folic acid? CVS Caremark takes aim at 'hyperinflated' drug prices: By removing five drugs with “hyperinflated” prices from its formulary, clients are saving $4.60 per member per year and patients are saving $15 per 30-day supply. One caveat— those drugs have very effective generic alternatives.

Big Pharma Sinks to the Bottom of U.S. Industry Rankings: In this Gallup poll, the" “pharmaceutical industry is now the most poorly regarded industry in Americans' eyes, ranking last on a list of 25 industries that Gallup tests annually. Americans are more than twice as likely to rate the pharmaceutical industry negatively (58%) as positively (27%), giving it a net-positive score of -31.” The “healthcare industry” is two notches higher. At the top? Restaurants!

Cannabidiol may interact with rheumatologic drugs: Many drug interactions are already known. but with widespread introduction of new or existing substances, there needs to be more education about these interactions. This article points out which rheumatologic drugs interact with CBD.

Walmart tests dentistry and mental care as it moves deeper into primary health: Like other pharmacies, such as CVS, Walmart is expanding into healthcare services. While it already has clinics in some stores, it is expanding its offerings into hearing screens, dentistry and behavioral health services.

About healthcare IT

Wearables market to hit $54B in 2023: "Wearables, which are smart electronic devices that can be worn or incorporated into clothing to track various health and wellness measures, are already ramping up in the healthcare space and taking on some serious clinical work.” These devices can help track patient health status, progress to recovery and also predict disease exacerbations.

Machine learning approach looks to reduce MRI scan times, costs: MRI scans take a long time. Speeding up the process can make better use of equipment and perhaps lower the price per scan. This article looks at the use of AI to reduce these scan times. One caveat— making MRIs more accessible may increase volume, and hence, overall costs. However, an MRI is one test that has been subject to strict utilization management.

Is that medical device interoperable? Center for Medical Interoperability program will verify it.: One of the big problems in healthcare IT is interoperability of devices with enterprise-wide systems. Now, “Nashville-based Center for Medical Interoperability is launching an industry-wide verification program to confirm medical device interoperability.

The project, called C4MI Verified, will test and verify medical devices to determine compliance with selected interoperability specification requirements…”

When Apps Get Your Medical Data, Your Privacy May Go With It [NY Times-subscription may be required]:While pending federal regs will require release of medical information to Apps after consumer permission, several large medical organizations point out that once released, that information is no longer protected by the HIPAA regulations. Since there are no laws governing further use, patient data can be sold for research or used for fraudulent purposes.

Industry Voices—8 ways technology plays a vital role in value-based healthcare: This article is a nice summary of what can be done using information to improve quality and patient satisfaction.

About health insurance

CMS extends ACO patient notification deadline to Oct. 1: “CMS at first required an ACO to notify a beneficiary they were in one when the program started in 2014, but the agency scrapped the requirement due to the extra staff time and confusion the notices caused seniors. However, CMS reinstituted the requirement when it set up ‘Pathways to Success,’ an overhaul of the Medicare Shared Savings Program. Pathways requires an ACO to take on financial risk earlier compared to the MSSP.” Perhaps out-of-network utilization will go down once patients are aware they are part of an ACO. Still, they are under no obligation to stay with the organization for care.

Did Medicare Advantage [MA]Payment Cuts Affect Beneficiary Access and Affordability?: The short answer is : No. “Although MA payment cuts were expected to reduce the attractiveness of the MA program to both plans and enrollees, the program’s enrollment grew steadily from 2009 to 2017. Over this period, plans reduced their costs for providing Part A and Part B benefits to their enrollees, thereby preserving room for rebates. Our findings show that plans made such cost reductions without significantly affecting enrollees’ access to or affordability of care compared with TM [traditional Medicare] beneficiaries.”