Have you ever read the #nutrition label on a muffin? If you want one with less sugar and fat, try one of these recipes.

Read the nutrition label on that muffin. It might look healthy, but it is likely heavy on sugar and fat.

For an alternative,try these recipes from the Harvard School of Public Health.

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Harvard Business Review on sexual harassment in health care

From HBR,  which has a three story pay-wall:

Many factors make an organization prone to sexual harassment: a hierarchicalstructure, a male-dominated environment, and a climate that tolerates transgressions — particularly when they are committed by those with power. Medicinehas all three of these elements. And academic medicine, compared to other scientific fields, has the highest incidence of gender and sexual harassment. Thirty to seventypercent of female physicians and as many as half of female medical students report being sexually harassed.

As we wrote in a recent New England Journal of Medicine article, “Imagine a medical-school dean addressing the incoming class with this demoralizing prediction: ‘Look at the woman to your left and then at the woman to your right. On average, one of them will be sexually harassed during the next 4 years, before she has even begun her career as a physician’.”

The NEJM

nci-vol-1884-150
National Cancer Institute archives

 piece is not:

The declaration of “Time’s Up” for medicine feels at once urgent and aspirational. Putting an end to the culture of gender-based harassment is key to recruiting, retaining, and realizing the full potential of the female-majority health care workforce, including 1 in 3 physicians, and feels long overdue. Actually running down the clock on harassment, however, will depend on our willingness to undergo a complete transformation in how we conceive of, approach, and prioritize this problem.

11/7 Live streamed Harvard event: “Addressing Adolescent Mental Health Beyond the Clinic: Lessons from the Global South”

Live streamed Harvard event on adolescent mental health beyond the clinic.  The Child Mental Health Forum talks run through May.

10 AM- 11:15 a.m.  at the Judge Baker Children’s Center
53 Parker Hill Avenue, Boston,
Limited free parking available

November 7th, 2018 “Addressing Adolescent Mental Health Beyond the Clinic: Lessons from the Global South”

Vikram Patel, MBBS, PhD

The Pershing Square Professor of Global Health and Wellcome Trust Research Fellow,
Department of Global Health and Social Medicine,
Harvard Medical School and Harvard TH Chan School of Public Health

Series runs through May ;

December 5th, 2018 “Genetics of Autism Spectrum Disorder”
Catalina Betancur, MD, PhD
Director of Research, INSERM Division,
Sorbonne University, Paris, France
January 9th, 2019 “Why do People Hurt Themselves? Using New Technologies to Better Understand, Predict, and Prevent Suicidal Behavior”
Matthew K. Nock, PhD
Edgar Pierce Professor of Psychology,
Harvard University
February 6th, 2019 “Gender Identity Development in Children and Adolescents”
Elizabeth Freidin Baumann, PhD
Instructor, Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School
Cynthia Telingator, MD
Assistant Professor of Psychiatry, Cambridge Health Alliance and Harvard Medical School
March 6th, 2019 “Exploring the Unique Needs of Adopted Teens: Four Essential Tasks for Parents and Providers”
Katie Naftzger, LICSW
Author of “Parenting in the Eye of the Storm: The Adoptive Parent’s Guide to Navigating the Teen Years.”
April 3rd, 2019 “Boys’ Friendships and the Crisis of Connection”
Niobe Way, PhD
Professor of Developmental Psychology,
New York University
May 1st, 2019 “Treatment Strategies for Sleep Disorders in Children and Adolescents”
Jess Shatkin, MD, MPH
Professor, Department of Child and Adolescent Psychiatry
Professor, Department of Pediatrics
New York University School of Medicine

STAT: :Neuroinflammation is where we’re going to find [Alzheimer’s] drugs.”

That’s what Rudolph Tanzi, a prominent Alzheimer’s researcher at MGH says about the work of Robert Moir, a member of his team.  A story in STAT last week — which ran in today’s Globe – chronicles Moir’s struggle to get funding for a theory that

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Alzheimer’s disease is a triggered by microbes in the brain.

If true, the finding would open up vastly different possibilities for therapy than the types of compounds virtually everyone else was pursuing, ” Sharon Begley writes…. 

If he and other scientists are right that beta-amyloid is an antimicrobial, that the brain goes on an amyloid-making immune rampage in response to pathogens, and that the rampage ignites neuron-killing inflammation, it suggests very different therapeutic approaches than the 30-year pursuit of amyloid destroyers.

“It used to be thought that stopping the plaques early was ‘primary prevention,’” Tanzi said. “I think primary prevention is stopping the microbes.” Treatment would mean leaving amyloid mostly alone (since it protects the brain from herpes and other viruses) but targeting inflammation, a biological fire that “kills 10 neurons for every one killed by amyloid and tau directly,” he said. “Neuroinflammation is where we’re going to find [Alzheimer’s] drugs.”

Noting the final paragraph. Not sure it applies here, but sometimes just a call from a reporter can move some wheels.  (See the Globe’s Fine Print column as an example.)

This month…(Moir) got an unheard-of email from NIH: The agency had found some extra money lying around in its budget. Would he please respond to the reviewers and resubmit his proposal? An over-the-moon Moir did. He expects to hear back in a few weeks.

KHN: Dialysis Giant DaVita Defends Itself In Court And At The Polls

This company has numerous local outlets, and this story includes a comment from HBS prof.  

It’s been a year of playing defense for DaVita Inc., one of the country’s largest dialysis providers.

A federal jury in Colorado this summer awarded $383.5 million to the families of three of its dialysis patients in wrongful death lawsuits. Then this month, the Denver-based company announced it would pay $270 million  to settle a whistleblower’s allegation that one of its subsidiaries cheated the government on Medicare payments.

But its biggest financial threat is a ballot initiative in California that one Wall Street firm says could cost DaVita $450 million a year in business if the measure succeeds.

Company's Boston locations
Company’s Boston locations

Despite these recent hits, the company continues to rake in profits and receive favorable ratings from stock analysts. Its shares are trading at about $65 a share, only about 19 percent below a 52-week high set in January. That’s largely because DaVita controls about one-third of a growing market, health experts say.

“They don’t really have many rivals, and they perform a necessary, lifesaving service,” said Leemore Dafny, a professor of business administration at Harvard Business School. “If you’re producing something people want to buy and you’re the only one making it, people are going to buy it.”

Patients with chronic kidney failure often need dialysis to filter the impurities from their blood when their kidneys can no longer do that job.

And as Americans live longer and get heavier, more people become diagnosed with kidney disease and possibly need dialysis. In 2015, 124,114 new patients received dialysis, up from 94,702 in 2000, a 31 percent increase, according to the U.S. Renal Data System.

DaVita is one of the largest dialysis providers in the country, operating more than 2,500 clinics nationwide. In California, the company operates 292 clinics, half of all chronic dialysis clinics in the state.

Its parent company, DaVita Inc., reported $10.9 billion in revenue last year and $1.8 billion in profits, almost all of which came from its dialysis business.

This year, company officials project the dialysis group will bring in $1.5 billion to $1.6 billion in profits. It’s a big turnaround for a corporation that could barely make payroll in 1999, when it was under review by the Securities and Exchange Commission for questionable accounting practices. Its success has largely been credited to CEO Kent Thiry, a colorful personality who has dressed up as a Musketeer and ridden a horse into corporate meetings to rally workers.

Now those big profits — generated from treating sick patients — has put a target on the company’s back, as well as that of its biggest competitor, Fresenius Kidney Care.

The Service Employees International Union succeeded this year in placing Proposition 8 on California’s Nov. 6 ballot, which would limit dialysis center commercial revenues to 115 percent of patient care costs. The ballot fight pits a well-funded industry against labor and the California Democratic Party.

DaVita declined to make anyone available for this article, but in a statement said Proposition 8 “will limit patients’ access to life-saving dialysis treatments, jeopardizing their care.”

Last year, roughly two-thirds of DaVita’s dialysis revenue came from government-based programs, such as Medicare and Medicaid. But that isn’t enough to cover its costs, according to the company’s 2017 annual report, which states that DaVita loses money on each Medicare treatment it provides. (Medicare covers dialysis for people 65 and older, and for younger patients after private insurance has provided coverage for 30 months.)

Instead, DaVita generates profits from commercial health plans, which it acknowledges pay “significantly higher” rates than government programs. The ballot measure targets those higher rates, which Dafny describes as “their bread and butter.”

The prospect of the measure passing led DaVita to delay or cancel plans to open new clinics in California despite growing patient demand, Javier Rodriguez, chief executive officer of DaVita Kidney Care, told investors on a call in May, according to the online equity research website Seeking Alpha.

A few months later, Rodriguez declined to provide a dollar amount when asked how the initiative would impact the company. Rather, he warned investors that it would become “unsustainable” for the industry to treat the estimated 66,000 dialysis patients in California, should the measure succeed.

Wall Street analysts agree that Proposition 8 would wipe out DaVita’s earnings in California, according to recent reports issued by investment firms J.P. Morgan and Baird. Passing the initiative “would be so devastating,” to the tune of $450 million a year, that DaVita “would likely walk away from the state altogether,” according to a March Baird report.

DaVita has poured $66.6 million into the opposition campaign as of Oct. 25, and rival Fresenius has contributed $33.6 million. That dwarfs $17.3 million in union contributions in support of the measure, according to campaign records filed with California’s secretary of state office.

Both Wall Street firms conclude that Proposition 8 is likely to fail, citing the industry’s massive spending and the union’s record of failure at the polls on other issues.

The company’s legal troubles don’t worry stock analysts, either; Baird’s October report on DaVita’s financial performance dedicates just two sentences to them. It notes that DaVita “is subject to numerous ongoing government investigations and inquiries, similar to most large-scale, high-profile Medicare providers.”

There are no specific references to the Colorado jury award this summer, which the company is appealing, over the death of three patients who died of cardiac arrest after treatment at DaVita clinics. Nor was there concern about this month’s $270 million settlement over Medicare billing.

That’s because those incidents are seen by investors as the cost of doing business — one-time hits that don’t affect a company’s earnings power in the future, said Matthew Gillmor, a senior research analyst at Baird.

“Almost all companies I follow, at some point, have had to pay a fine to the government,” Gillmor said.

Thiry, DaVita’s CEO, acknowledged that settlements, which aren’t good public relations, are a reality for large corporations, when The Denver Post asked him last year about the company’s previous legal battles.

“If, in a trial, you are found to be wrong on even a small part of the case, it could mean that you are excluded from Medicare, which typically would mean bankruptcy for your company,” Thiry said. “So, you are essentially forced to settle.”

Harriet Rowan of California Healthline contributed to this report.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

KHN: Drugmakers Funnel Millions To Lawmakers; A Few Dozen Get $100,000-Plus

Before the midterm elections heated up, dozens of drugmakers had already poured about $12 million into the war chests of hundreds of members of Congress.

Since the beginning of last year, 34 lawmakers have each received more than $100,000 from pharmaceutical companies. Two of those — Reps. Greg Walden of Oregon, a key Republican committee chairman, and Kevin McCarthy of California, the House Republican majority leader — each received more than $200,000, a new Kaiser Health News database shows.

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As voters prepare to go to the polls, they can use a new database, “Pharma Cash to Congress,” tracking up to 10 years of pharmaceutical company contributions to any or all members of Congress, illuminating drugmakers’ efforts to influence legislation.

The drug industry ranks among lawmakers’ most generous patrons. In the past decade, Congress has received $79 million from 68 pharma political action committees, or PACs, run by employees of companies that make drugs treating everything from cancer to erectile dysfunction.

Drugmakers’ campaign contributions have reached record-breaking levels in recent years as skyrocketing drug prices have become a hot-button political issue. By June 30, 52 PACs funded by pharmaceutical companies and their trade organizations had given about $12 million to members of Congress for this election cycle. It is unclear whether drugmakers will top their previous 10-year record of $16 million, given during the 2016 election season.

While PAC contributions to candidates are limited, a larger donation frequently accompanies individual contributions from the company’s executives and other employees. It also sends a clear message to the recipient, campaign finance experts say, one they may remember when lobbyists come calling: There’s more where that came from.

The KHN analysis shows that pharmaceutical companies tend to play the field, giving to a wide swath of lawmakers on both sides of the aisle.

The drug industry favors power. Since the beginning of 2017, drugmakers contributed to 217 Republicans and 187 Democrats, giving only slightly more on average to Republicans, who currently control both chambers of Congress. This was also the case for Democrats during the 2010 election cycle, when they controlled Congress.

As with other industries, drugmakers tend to give more to lawmakers in leadership roles. For example, Rep. Paul Ryan, a Wisconsin Republican, became speaker of the House halfway through the 2016 election cycle, prompting drugmakers to pour $75,000 more into his war chest than they had the previous cycle.

Money also tends to flow to congressional committees with jurisdiction over pharmaceutical issues that can affect things like drug pricing and FDA approval. Walden, a nine-term Republican congressman, has watched his coffers swell with help from drugmaker PACs since he became chairman of the powerful House Committee on Energy and Commerce in early 2017.

With six months to go in the 2018 cycle, Walden had already raised an additional $71,000 over the 2016 cycle — or 11 times more than drugmakers gave him a decade ago.

Asked to comment on the increase in Walden’s contributions from drugmakers, Zach Hunter, his committee spokesman, called attention to Walden’s work to lower prescription drug prices and said “no member of Congress has done more” to end the opioid crisis.

Pharmaceutical company PACs also gave to dozens of other members of committees, such as the Senate Committee on Health, Education, Labor and Pensions. And they appear to target congressional districts that are home to their headquarters and other facilities.

The PAC for Purdue Pharma, the embattled opioid manufacturer, gave to only a handful of members this cycle. However, it focused much of its giving on lawmakers from North Carolina, its headquarters for manufacturing and technical operations.

This election cycle, 28 percent of lawmakers did not receive any contributions from pharmaceutical PACs.

Under federal law, corporations cannot donate directly to political candidates. Exploiting a common loophole, they instead set up PACs, funded by money collected from employees. Those PACs then donate to campaigns, which are free to spend that money as they wish on necessities like advertising or campaign events.

Campaign contributions tell only part of the story. Drugmakers also spend millions of dollars lobbying members of Congress directly and give to patient advocacy groups, which provide patients to testify on Capitol Hill and organize social media campaigns on drugmakers’ behalf.

A previous investigation by Kaiser Health News, “Pre$cription for Power,” examined charitable giving by top drugmakers and found that 14 of them donated a combined $116 million to patient advocacy groups in 2015 alone.

And like other industries, pharmaceutical companies wield their political power in ways veiled from the public, giving to “dark money” groups and super PACs — independent groups barred from directly donating to or coordinating with campaigns — bent on swaying lawmaking.

Brendan Fischer, who directs federal reform programs at the Campaign Legal Center, cautioned that a campaign contribution from a corporate PAC does not directly translate into a vote in the drugmaker’s favor.

“Contributions help keep the door open for company lobbyists,” he said.

KHN data editor Elizabeth Lucas contributed to this story.

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

 

Is the US setting the bar too low for new CF drug? Canada says it’s not worth it

From The Globe and Mail:

Canadian governments should not pay for a $250,000-a-year cystic fibrosis medication because it is not clear the drug actually improves patients’ health, according to a fresh review that has devastated some with the potentially fatal lung disease….

Screen Shot 2018-10-15 at 9.06.47 AMIn a report released on Thursday, the CADTH’s expert panel said its review of the Orkambi clinical trials and other studies found the drug produced only slight improvements for about one in four patients.

The report also said Orkambi’s Boston-based maker, Vertex Pharmaceuticals, would have to slash the drug’s price by more than 98 per cent to satisfy the agency’s value-for-money analysis.

“[Orkambi] is better than nothing. It’s better than placebo,” said Trevor Richter, director of the CADTH’s Common Drug Review, which oversees the review process for non-cancer medications. “But the benefit is really small. Not only is it small, but there’s a huge amount of uncertainty about what the actual size of that benefit is.”…

Vertex called the agency’s recommendation “deeply disappointing.”

Patients, who say the drug benefited them, are suing.

Mr. Richter of the CADTH said it is difficult but necessary sometimes to disappoint patients.

“We don’t enjoy delivering recommendations that are seen as negative,” he said. “In the end, we are an evidence-based review process. It’s rigorous and it’s transparent.”