The New Yorker:#Boston researchers are hunting for a #Zika vaccine — trco201

The August 22 edition of The New Yorker includes a story by Siddhartha Mukhergee on Dan Barouch, director, Center for Virology and Vaccine Research at BIDMC. He’s on the hunt for a Zika vaccine and his work on HIV is informing the effort. From the article, which is not behind the NYer pay wall:

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Will genetic advances address health disparities? Not much unless they are accessible.

The new issue of Health Affairs looks at health policy and health disparities. Many local researchers represented.

Of interest: Using Genetic Technologies To Reduce, Rather Than Widen, Health Disparities

The authors include two local researchers: Katherine L. Tucker is a professor in clinical laboratory and nutritional sciences at the University of MassachuseCapturetts, in Lowell…José M. Ordovás is director of the Nutrition and Genomics Laboratory at the Human Nutrition Research Center on Aging at Tufts University

Evidence shows that both biological and nonbiological factors contribute to health disparities. Genetics, in particular, plays a part in how common diseases manifest themselves. Today, unprecedented advances in genetically based diagnoses and treatments provide opportunities for personalized medicine. However, disadvantaged groups may lack access to these advances, and treatments based on research on non-Hispanic whites might not be generalizable to members of minority groups. Unless genetic technologies become universally accessible, existing disparities could be widened. Addressing this issue will require integrated strategies, including expanding genetic research, improving genetic literacy, and enhancing access to genetic technologies among minority populations in a way that avoids harms such as stigmatization.

And, a team from Harvard offers this :

Across US Hospitals, Black Patients Report Comparable Or Better Experiences Than White Patients

Patient-reported experience is a critical part of measuring health care quality. There are limited data on racial differences in patient experience. Using patient-level data for 2009–10 from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), we compared blacks’ and whites’ responses on measures of overall hospital rating, communication, clinical processes, and hospital environment. In unadjusted results, there were no substantive differences between blacks’ and whites’ ratings of hospitals. Blacks were less likely to recommend hospitals but reported more positive experiences, compared to whites. Higher educational attainment and self-reported worse health status were associated with more negative evaluations in both races. Additionally, blacks rated minority-serving hospitals worse than other hospitals on all HCAHPS measures. Taken together, there were surprisingly few meaningful differences in patient experience between blacks and whites across US hospitals. Although blacks tend to receive care at worse-performing hospitals, compared to whites, within any given hospital black patients tend to report better experience than whites do.

 

 

 

From ob/gyn to surgery, MGH study found salaries for male doctors higher than #female #doctors at public US #medical #schools

From JAMA Internal Medicine:

  • Question Do differences in salary exist between male and female academic physicians in US public medical schools?

  • nci-vol-1926-150

    Just like the old days? 

    Relying on Freedom of Information laws that mandate release of salary information of public university employees in several states, this study analyzed sex differences in academic physician salary among 10 241 physicians in 24 public medical schools. Accounting for physician age, experience, faculty rank, specialty, scientific authorship, National Institutes of Health funding, clinical trial participation, and Medicare reimbursements, female physicians earned less than males.

  • Meaning Significant sex differences in salary exist in public medical schools after accounting for clinical and research productivity.

Well, not  everywhere. More from The New York Times

The researchers also found stark variations in the salary gap at different medical schools, suggesting some address pay inequities more aggressively than others.

“The biggest surprise is there are some schools where this doesn’t seem to be an issue,” said Dr. Anupam B. Jena, the study’s lead author and an associate professor of health care policy at Harvard Medical School.

#Massachusetts cares if #doctors have conflicts of interest, but do #patients care?

The Globe offers a peek at the drug company marketing/meals at smaller hospitals

Years after many big academic medical centers cracked down on industry perks, drug companies still regularly buy meals bll-leg-pix-webfor doctors affiliated with smaller hospitals, a new analysis shows, with some physicians receiving dozens of lunches and dinners in a single year.

At a number of community hospitals, well over half of the affiliated doctorswere beneficiaries of industry payments, suggesting there may be fewer restrictions on meals there than at large teaching hospitals.

Worth noting a UMass led-research mentioned in an NYTimes  column on medical conflicts of interest. The study by orthopedic surgeons reported that about 80 percent of patients “felt it was both ethical and either did not influence, or actually benefited their health care, if their surgeons were consultants for surgical device companies.”

Here’s a look at more data from the study:

Six hundred ten of 642 surveys had complete data. The sample population comprised more females and was older and more educated than the American population. About 80% of respondents felt it was ethical and either beneficial or of no influence to the quality of health care if surgeons were consultants for surgical device companies. Most felt disclosure of an industry relationship was important and paying surgeons royalties for devices, other than those they directly implant, would not affect quality of care. Respondents support multidisciplinary surgeon-industry COI regulation and trust doctors and their professional societies to head this effort.

Almost 40% of respondents felt the quality of care would be adversely affected if a surgeon received royalty payments for a medical device that would be implanted by that surgeon….  When questioned about who should be involved in regulation of COI, a majority of respondents (64.3%) felt that a combination of doctors, hospitals/universities, government, and company representatives should be involved; 34.9% of respondents felt that medical professional societies run by doctors should have the most control over COI regulation, almost two times more than the next most frequent answer; and 44.9% and 26.3% (70.2% combined) of respondents felt medical company representatives and government officials should not be involved in the regulation of COI….

Our survey found that 91% of respondents felt it was important for surgeons to disclose consulting agreements regarding devices in their
surgery (Table 3). Furthermore, 60% of respondents thought it was appropriate for surgeons to disclose consulting arrangements with all patients regardless of the planned usage of such devices in their own surgery

Also noted in the study

Leaders of the American Academy of Orthopedic Surgeons have recently made a consensus statement that the enhancement of patient care has and will continue to require orthopedic surgeons to collaborate productively with industry in the development of new technology and techniques

Also worth noting that a 2013  UConn study found the following

Overall, patients had a poor understanding of FCOI (financial conflict of interest.) Both level of education and previous discussions of FCOI predicted better understanding. This study emphasizes communication of FCOI with patients needs to be enhanced.

Finally, a Health Affairs blog post on patients and COI noted:

Physician ownership of orthopedic or spine hospitals has been correlated with higher rates of spine surgery. In these situations, doctors must keep these centers busy with procedures in order to generate profits and prevent losses; overhead costs are high, including financing, staffing, lease arrangements, and insurance. However, a busy center becomes a lucrative profit center for owning physicians.

 

 

NEJM: One man’s tragic try at “stem cell” therapy. Will we soon be seeing ads for overseas CRISPR clinics?

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Ad for one program.

A local man has been crippled by a growth on his spine that developed after he traveled overseas to a so- called stem cell clinic. The growth was not from his own cells. So, not only is the treatment untested, doctors don’t know what to do about the bad outcomes.

Here’s the technical explanation from The New England Journal of Medicine:

Commercial stem-cell clinics have been highly publicized in the lay press and operate worldwide with limited or no regulation. We report the case of a 66-year-old man who underwent intrathecal infusions for the treatment of residual deficits from an ischemic stroke at commercial stem-cell clinics in China, Argentina, and Mexico. He was not taking any immunosuppressive medications. In reports provided to him by the clinics, the infusions were described as consisting of mesenchymal, embryonic, and fetal neural stem cells. Progressive lower back pain, paraplegia, and urinary incontinence subsequently developed. Magnetic resonance imaging (MRI) revealed a lesion of the thoracic spinal cord and thecal sac; a biopsy specimen was obtained

This from the Globe story

Brigham pathologists tested the tissue taken from Gass’s spine and determined it was a tumor-like growth but did not have mutations associated with cancer and therefore could not be treated with chemotherapy. Most of the cells were not Gass’s but from another source.

“It’s hard to know what to call it,’’ Chi said.

Doctors have treated Gass with radiation to shrink the mass, which has helped somewhat, but they are also searching for other solutions.

Doctors have been increasingly warning that stem cell clinics are proliferating around the world with little oversight. They are promoting their methods to patients suffering from strokes, amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease), Alzheimer’s, and other conditions for which there are few good options. Professional athletes have helped popularize the clinics by seeking out stem cell therapy for strokes and shoulder and knee injuries.

 The NYTimes also has a story. 

My father’s brain is missing  

Not my father's brain

Not my father’s brain

Certain that years of meds, scotch, steak and surliness had gotten to my Mad Men-era dad, we agreed to donate his brain to Harvard. He came up clean – not a trace of damage or plaque.

The findings are actually missing, not the samples.

The Boston Globe reports:

McLean Hospital said Tuesday that information about 12,600 people who donated their brains to research has gone missing. McLean, a psychiatric hospital in Belmont owned by Partners HealthCare, said most of the people affected are deceased. The others are people who have committed to donating their brain tissue to medical research upon their death. Some family members of brain donors also were affected.

The hospital said four backup data tapes at its Harvard Brain Tissue Resource Center went missing on May 29. These tapes contained private information, including names, dates of birth, diagnoses, and some Social Security numbers. The tapes, which are unencrypted, were never found.

Should the FDA approve Vertex’s new cystic fibrosis drug?

The scene at the FDA hearing was familiar. All the  advisory committees have seen it play out again and again. Yesterday, it was the Pulmonary-Allergy Drug committee: The pharma doc with the convincing statement. The weeping patients. The drug likely to cost a couple thousand a month offering a slim  benefit over an existing drugs. But it works, and it’s safe.

From the Globe:VertexLogoSOP

“I think this is a much-needed advance for patients with cystic fibrosis,” said committee member Dr. Michelle S. Harkins, associate professor of medicine at the University of New Mexico Albuquerque, one of the majority voting to recommend approval.

The lone dissenter in the 12-1 vote recommending approval of the drug, Dr. Yanling Yu, the president and cofounder of Washington Advocates for Patient Safety in Seattle, said she was not convinced the data generated by the Vertex testing supported the approval of Orkambi.

“I really understand the patients critically need a new drug, but sometimes a new drug does not provide [the needed effectiveness],” she said.

From The New York Times story:

An issue for the advisory committee was that Orkambi had what the F.D.A. said was only modest effectiveness, improving lung function by only about 3 percentage points relative to placebo.

Some family members or advocates, some of them crying, pleaded with the committee to endorse the drug.

Some patients who took the drug in clinical trials said it had made a huge difference in their lives, reducing their coughing, allowing them to exercise better, helping them gain weight or reducing how often they ended up in the hospital…

Michael Yee of RBC Capital Markets, for instance, expects the price will be $225,000 to $250,000 a year.

The vote is advisory. The FDA staff will make the final call.

More here:

The financial stakes for Vertex.

FDA briefing for meeting.

Vertex briefing for the meeting

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