Video: Harvard School of Public Health: The Chronic #Pain Epidemic

Will 21st Century Cures Act benefit hospitals?

captureFirst: The Globe is getting some attention for its five-part narrative about a family that helped  start a drug company to keep their son on an experimental cancer treatment.

Nicely written narrative with illustrations and audio. We won’t give away the ending. 

Also, here’s what people were saying a year ago about the “21st Century Cure Act.” It’s been amended since then, but much of what they have to say still applies. My take was: What’s in it for hospitals? 

The drug development and approval elements in the proposed legislation are the centerpiece of a gift basket that has something for everyone: engaged patients, drug makers, FitBit fanatics, NIH-funded scientists, those faced with rare diseases, and those fighting antibiotic resistance.

What do hospitals get out of it? Of course, it depends on whom you ask. One side says it will clear out bottlenecks that are delaying access to better drugs and new, effective antibiotics. That’s good news for hospitals struggling to improve patient outcomes and prevent readmissions. The other side says it will lead to unsafe drugs and a flawed approach to dealing with antibiotic resistance. That’s bad news for hospitals struggling to improve patient outcomes and prevent readmissions.

John Powers, MD, is a former head of the FDA’s Antimicrobial Drug Development and Resistance Initiatives. He is now a clinical professor at the George Washington University School of Medicine and one of the bill’s critics. If the bill’s provisions regarding FDA approval become law, hospitals should be worried that they will be held responsible for drugs that are ineffective or worse, he said.

“If you have a new drug and it doesn’t make the patient better, what you actually end up doing is spending more money in the long run because they stay in the hospital longer,” Powers said. “Or you may have to administer additional treatment to deal with the side effects of that medicine — which costs money.”

Live streaming right now: “How does where you live affect your health.”#BUSPH40 #BUSPHSymposia #environment #public health

Lots of health news in Boston this week, but at the moment, check out the live stream of this event.capture

Can the physical and social aspects of your neighborhood influence your health? The symposium will explore the roles of the built environment and housing and will evaluate the science on how interventions can improve the health of vulnerable populations.

 

Agenda

8:30–9 a.m.
Breakfast and Informal Greetings

9–9:15 a.m.
Welcome and Opening Remarks

Sandro Galea, Dean and Robert A. Knox Professor, Boston University School of Public Health

Jonathan Levy, Professor, Environmental Health, Boston University School of Public Health


BUILT ENVIRONMENT AND HEALTH
9:15–10 a.m.

Howard Frumkin, Professor of Environmental and Occupational Health Sciences, School of Public Health, University of Washington


10–11:30 a.m.

Panel Discussion: Separating Neighborhood-Level from Individual-Level Risk Factors

Mariana Arcaya, Assistant Professor, Urban Studies, Massachusetts Institute of Technology

Yvette Cozier, Assistant Dean for Diversity and Inclusion and Assistant Professor, Epidemiology, Boston University School of Public Health

Theresa Osypuk, Associate Professor, Epidemiology and Community Health, University of Minnesota School of Public Health

Shakira Suglia, Associate Professor, Epidemiology, Emory University Rollins School of Public Health

Monica L. Wang (Moderator), Assistant Professor, Community Health Sciences, Boston University School of Public Health


HOUSING AND HEALTH
11:30 a.m.–12:30 p.m

Ron Sims, Former Deputy Secretary of the United States Department of Housing and Urban Development


12:30–2 p.m.

Panel Discussion:  The Influence of Housing on Health

Carlos Dora, Coordinator, Public Health and the Environment Department, World Health Organization

Patricia Fabian, Research Assistant Professor, Environmental Health, Boston University School of Public Health

David Jacobs, Chief Scientist, National Center for Healthy Housing

Megan Sandel, Associate Professor, Pediatrics, Boston University School of Medicine

John Spengler (Moderator), Akira Yamaguchi Professor of Environmental Health and Human Habitation, Harvard T.H. Chan School of Public Health


2–2:10 p.m.

Break


2:10–3:40 p.m

Panel Discussion: High-Risk Populations and Strategies to Improve Health

Kalila Barnett, Executive Director, Alternatives for Community and Environment

JoHanna Flacks, Legal Director, Medical-Legal Partnership | Boston (MLPB)

Hector Olvera, Associate Professor and Director of Research, University of Texas at El Paso School of Nursing

Madeleine Scammell, Assistant Professor, Environmental Health, Boston University School of Public Health

Carey Goldberg (Moderator),  Health and Science Reporter, WBUR


3:40–3:45 p.m.

Closing Remarks

Jonathan Levy, Professor, Environmental Health, Boston University School of Public Health

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.

Boston Globe: Sachs, Angell, weigh in on health care reform

Jeffrey  Sachs of  Columbia University is not a health care guy; he’s a big picture guy. One in  a series of lengthy columns in The Boston Globe offered this:

captureOBAMACARE INCREASED health care coverage but did not solve the crisis of sky-high prices, and may well have exacerbated it by adding government subsidies into a system marked by pervasive market power and lack of competition.

I therefore recommend the following policies to address America’s urgent health care crisis.

First, as I’ve suggested in previous articles in this series, America should adopt policies to reduce income inequalities, end the over-incarceration of the poor, empower workers, clean and green the environment, and raise the social status of working-class families. Over time, such measures would help to reverse the epidemics of drug abuse, mental illness, obesity, and other diseases exacerbated by poverty and low social status.

Second, America should move toward universal health care coverage through public financing, as in Canada and Europe, with health providers (both private and not-for-profit) supplying coverage on the basis of capitation rather than fee-for-service. Capitation would encourage and enable health providers to offer supportive services (nutrition counseling, social support, health advising) that help to prevent, treat, and manage chronic conditions such as cardiovascular disease and adult-onset diabetes.

Third, the government should move to a system of price ceilings for medicines under patent through rational guidelines that balance the incentives for R&D with drug affordability and access. Economists have long argued that today’s patent law does not do an adequate job of balancing the needed incentives for innovation with the assurance of access to affordable medicines. The situation became intolerable after the advent of Medicare Part D, with the government now spending vast sums for drugs and drug companies grossly abusing the system by setting outrageous markups on the cost of production.

None of this is a dream or a utopian vision. These reforms would simply put the United States on the path toward improved health care coverage, affordability, and outcomes already enjoyed by the citizens of Canada, Japan, and many countries in Europe.

To which Dr. Marcia Angell, a former NEJM editor vocal critic of health care profiteering, had this to say:

JEFFREY D. SACHS has written an excellent overview of what makes the American health system so inadequate, inequitable, and expensive, compared with other advanced countries, and he recommends some important reforms. But one of them — paying providers a set yearly amount for each patient covered (capitation), instead of paying on a fee-for-service basis — would not work in this country, because, unlike other countries, our providers are largely for-profit (or behave that way).

Should Boston Children’s Hospital expansion go forward? Opponents cite higher costs, smaller garden.

Planned to write a post linking to the wave of endorsements and opposition to the proposed expansion at Boston’s Children’s Hospital, but the Globe columnist Joan Vennochi did it for me. Her opinion piece  links to the various supporters -Gov. Charlie longwood map Globe’s staff editorial endorsing the plan.  BHN is in the reporting, not the endorsing, business. So, FYI.

The need for Children’s to renovate old quarters is not in dispute. But its expansion needs are open to question. Children’s says it will fill beds from national and international referral sources. But it has been working to expand its referral network in Massachusetts. In the past 24 months, Children’s has filed numerous notices of material change about new arrangements to either acquire physicians or become the preferred provider. That suggests the hospital expects to take volume from the current marketplace. At the same time, it will drive up costs, since the hospital has also said it expects to get commercial insurance and Medicaid rate increases every year.

As the Children’s plan moves forward, Massachusetts is under pressure to reduce state health care costs, with spending on Medicaid — the health program for the poor and disabled — already flagged as a trouble spot.

Competitors like Tufts Medical Center and Massachusetts General Hospital — which is part of the Partners network — are also worried that a larger Children’s will dominate the pediatric hospital landscape. To add to the intrigue, Jack Connors, who was chairman of the Partners board from 1996 to 2012, is backing Children’s and essentially undercutting the concerns of MGH doctors. “If you’re successful in business, you grow,” Connors told the Globe.

Ah, business. In the end, is that what this is all about?

Health Leaders: #Lacks family members now have a say in #Henrietta’s immortal scientific legacy

My report from Health Leaders on a recent talk by members of Henrietta Lacks’ famfile_000-4ily.

The ongoing story of the late Henrietta Lacks, the African-American
woman who unwittingly provided cells for years of medical research, has much to offer those battling disparities
in healthcare, according to family members who spoke in Boston last week.

That message, delivered at a panel discussion, came from Lacks’ grandson David Lacks, Jr. and her great granddaughter Victoria Baptiste, RN, as well as Joseph Betancourt, MD, director of the Disparities Solutions Center at Massachusetts General Hospital.

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