Harvard, STATnews hold forum on “21sth Century Cures Act” #research #FDA #NIH

 

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NIH, Bethesda, Maryland

The Harvard Gazette, the school’s in-house newsletter, has a summary of the forum. A video will be available here at some point or find it on Facebook Live.

Note that NEJM editor Jeffrey Drazen said “The NIH is undergoing a slow strangulation,…Money is what drives research. You need the resources when you have an idea.”

Lots of people say this.If you argue that more money for research is always good, you agree. And if you are one of the many, many scientists trying to get the NIH money to fund a project, life is a lot harder. But, is there such a thing as evidence-based research funding? Are we getting outr money’s worth?

Note that NIH’s budget doubled between 1999 and 2003.  Funding started to decline with the 2008 financial crisis, and it’s been pretty level since then. That’s the equivalent of a decline with inflation.

Still,  to many, more is better and level is less. So the increased funding for NIH in the bill perhaps sweetened the provisions in the “21st Century Care Act”  that will speed FDA approval of new drugs. That’s good news for those who will get better and richer from new drugs. Bad news for those worried that FDA oversight is already lax. Two of the speakers expressed some “concern about speeding up the FDA’s drug approval process, saying that will result in decisions based on less-rigorous science.”

 

 

Report to call for state #oversight of #hospital rates in #Massachusetts

A little noticed story about a little noticed report. From the Globe:

download-1In an effort to tackle one of the biggest challenges to the Massachusetts economy, members of a special state commission on Tuesday called for regulating the growth in hospital rates to contain health care costs.

Commissioners said the Division of Insurance should have greater authority to oversee hospital-insurer contracts, including the amount hospital rates can increase each year. The controversial proposal comes after months of discussions at the commission, which was convened to study the wide variation in prices at Massachusetts hospitals. Studies have shown that price disparities contribute to higher health spending because the most expensive providers also tend to have the top reputations and attract the most patients.

On the same day, The Massachusetts Health Policy Commission (HPC) released its annual report on health care spending in Massachusetts in 2016.  Main drivers of health care cost growth are  prescription drug costs, hospital spending, health insurance enrollment changes, and  spending on long-term services. 

Why two commissions? On is a quasi-state agency, the other a one-off , set up when hospitals unions agreed not to pursue a ballot question that would have regulated insurance payment to hospitals. The commission was charged with “recommending steps to reduce price variation among different providers and issuing a report by March 15, 2017,” according to the Globe.

And this Sunday, the Globe reported on another attempt to limit the cost of Medicaid in the state”

Governor Charlie Baker “has been backed into a corner by the soaring expense of MassHealth, the state’s publicly subsidized health insurance program for lower-income residents. MassHealth now accounts for about 40 percent of the state budget, and he fears that even more people will choose it over their employer’s coverage.

To help keep that from happening, the governor last month unveiled a measure that would penalize companies that don’t offer adequate health insurance to their workers.”

 

Jury: Double-booked surgery did not lead to injury

From The Globe.

A Boston jury on Monday found that a spine surgeon at Massachusetts General Hospital failed to i

nform a Westwood financial analyst that he planned to operate on two patients at once, but the jury concluded that the doctor’s divided attention did not cause the man’s quadriplegia.

As a result the jury awarded Tony Meng, a 45-year-old father of two, no financial damages…

Meng’s disastrous operation figured prominently in a Globe Spotlight Team investigation of simultaneous surgeries at MGH and other teaching hospitals. Many hospitals have since restricted the practice, also known as “concurrent surgery,” and a US Senate committee recently sought to curb it.

Two other former patients of Wood’s have sued him for medical malpractice alleging that double-booking contributed to their complications. One of the patients is former Red Sox relief pitcher Bobby Jenks, who blames Wood for what he alleges was a botched back operation in 2011 that ended his career.

For more on the Globe series, click on the link above or see this interview with Spotlight Team editor Scott Allen

Massachusetts #universal health coverage effort carries on

Here in Massachusetts, life goes on in terms of universal coverage.From The Boston Globe:

Health-insurance sign-ups are running ahead of expectations as the Massachusetts Health Connector wraps up the second month of the three-month open-enrollment period, according to Louis Gutierrez, executive director.

The Connector, a state agency that serves people who don’t obtain health insurance through an employer, has drawn in more than 27,600 new enrollees since open enrollment began Nov 1. And Gutierrez expects to see many more before the sign-up period ends on Jan. 31.

WBUR reports that coverage may change:

imgrese head of the Massachusetts Health Connector, Louis Gutierrez, says no matter what happens with the ACA, the Connector is committed to providing affordable coverage, as it has since the state’s own health care overhaul went into effect in 2006. Since then, the ACA has helped the state expand its Medicaid and Medicare programs.

Gutierrez is hesitant to guarantee enrollees will get to keep the exact coverage they signed up for this year, regardless of what happens in Washington. “I can’t make commitments about things I can’t personally control,” he said.

Should #STAT take ads from drug industry lobbyists at #PhRMa?

While acknowledging the quality of the reporting at STAT — and the search for new revenue  to support good journalism — Health News Review wonders why The Boston Globe life science spin-off has to take ads from the pharmaceutical industry’s top lobbying group.

Some STAT readers might see PhaRMa as a champion of just another health-related indstat-phrma-sponsorshipustry, like medical software or consulting services.  Others question the industry’s research, pricing and marketing practices as evidence of a commitment to profits over healing and access.

So, HNR argues that the ads allow the “industry to buy juxtaposition to messages that often call their practices into question.”  

Worth noting that my STAT newsletter arrives with different sponsors on different days. Last week’s included J&J, Amgen, a life science software maker, or none at all.

From HNR:

I am sure that STAT allows no editorial influence by this or any other sponsor. Their hard-nosed coverage of pharmaceutical industry news is top notch…

 

But I do not praise their front office decision to accept this sponsorship deal. It startles me and bothers me every time I see that PhRMA logo on the STAT newsletter. And I think it could raise legitimate questions in discerning readers’ minds.  Journalism ethics dictates that one should strive at all costs to avoid even the appearance of a conflict of interest. Was it necessary for STAT to enter into this sponsorship deal?  STAT just introduced a premium subscription plan.  I hope that works for them; maybe it will generate enough income so that they wouldn’t feel compelled to swim in the murky waters of the PhRMA sponsorship deal…

Certainly PhRMA is thrilled with STAT saying “Yes” –  allowing them to buy their way into regular appearances in the STAT newsletter. This is a foot in the door for an industry to buy juxtaposition to messages that often call their practices into question. It would be understandable if any reader’s head was spinning with thoughts of “What’s going on here?”

Don’t take your #vitamins, says doctor from the Cambridge Health Alliance

fruit-photoEven though it is affiliated with Beth Israel Deaconess Medical Center, the Cambridge Health Alliance is often overlooked in this land of huge, lauded teaching hospitals. But Dr. Pieter A. Cohen’s editorial about supplements in JAMA gets a mention in  a story in this Tuesday’s Well column  in The New York Times.

Americans spend more than $30 billion a year on dietary supplementsvitamins, minerals and herbal products, among others — many of which are unnecessary or of doubtful benefit to those taking them. That comes to about $100 a year for every man, woman and child for substances that are often of questionable value…

In an editorial entitled “The Supplement Paradox: Negligible Benefits, Robust Consumption” accompanying the new report, Dr. Pieter A. Cohen, of Cambridge Health Alliance and Somerville Hospital Primary Care in Massachusetts, pointed out that “supplements are essential to treat vitamin and mineral deficiencies” and that certain combinations of nutrients can help some medical conditions, like age-related macular degeneration. He added, however, “for the majority of adults, supplements likely provide little, if any, benefit.”

Among the changes found in the new study: multivitamin/mineral use declined to 31 percent from 37 percent, “and the rates of vitamin C, vitamin E and selenium use decreased, perhaps in response to research findings showing no benefit,” Dr. Cohen wrote. Sometimes people do act sensibly when faced with solid evidence.

Would you take a pill to prevent AIDS? Those at risk should consider it, says Massachusetts.

The Globe reports today on the push to make Capturean AIDS prevention drug available. After
many years of struggling to come up with a vaccine, this was a true breakthrough. (We don’t use that word lightly on this page.) But instead of a shot that stays with you for year, here you have to take a pill.

Critics questioned the wisdom of giving powerful drugs to healthy people, and worried that access to a preventive drug would encourage promiscuity or lead to a spike in other sexually transmitted diseases by reducing condom use.

But as study after study — some conducted in Boston — found the drug safe and effective, public health officials came to embrace PrEP, concluding the benefits exceed the hazards. The US Centers for Disease Control and Prevention estimates that some 1.2 million people at risk of HIV infection should at least consider PrEP.