Boston researchers find high #spending on docs doesn’t produce better care

A group of doctors from a range of Boston-area institutions looked at patient outcomes and physician. Their findings were published online via JAMA Inte33586416554_c4c88c0477_zrnal Medicine.  Abstract here. 

While the substantial variation in health care spending across regions and hospitals is well known, key clinical decisions are ultimately made by physicians. However, the degree to which spending varies across physicians and the clinical consequences of that variation are unknown…Health care spending varies more across individual physicians than across hospitals. However, higher physician spending is not associated with better outcomes of hospitalized patients. Our findings suggest policies targeting both physicians and hospitals may be more effective in reducing wasteful spending than policies focusing solely on hospitals.

Full editorial: 

The new data on physician spending in Medicare align with previous data on geographic variation in spending. Higher spending (reflecting greater utilization of health care services) did not translate into better health outcomes. From this study, we can conclude that differences in the utilization of health care services among hospitalists are not associated with differences in clinical outcomes, adding to the growing body of fascinating research on the complex relationship between spending and health.



Nature Boston: Who in town is getting funded to do biomedical? #research #NIH

Nature Boston takes a trip through the NIH grants database and finds that the number of new grants dropped quite a bit last year.

While the agency funded 403 new projects in Massachusetts in 2010, that number dropped to 335 in 2011.

Does that make the grant winners super superstars? Or was the research in the labs at the right place at the right time? So many variables go into NIH funding, it can be hard to tell. Still it’s worth looking at where the money is going.

The 11 new winners so far for 2012 are looking into influenza, herpes, DNA replication timing, structural vaccinology for malaria and the search for biologically active antitumor and anti-infective agents in natural products. Our data is current as of this morning, but the numbers change constantly as NIH adds new grants to the database.  Grants went to Boston University, UMass med school and Brandeis University. But, Harvard-linked researchers – and infectious disease — dominate the list.

For more, head over to NB. While you are there, check out the site’s well-curated list of science events.


Did news reports miss the message on IOM breast cancer/environment study?

Earlier this week, we cast this IOM study as offering little new news.  But, as Julia Brody of  The Silent Spring Institute points out, that’s not quite true.  From the environmental Health News website:

…(M)ost of the news media missed the significance of the assessment on environmental chemicals. The real news is that the report is an authoritative statement that a cascade of scientific evidence plausibly links consumer product chemicals and pollutants with biological activity suggesting breast cancer risk.

Instead of saying what is in the report, glass-empty stories said that the IOM “failed” to “definitely” link any chemicals to breast cancer or find “clear” environmental links. Some incorrectly said the report tells women to stop worrying about consumer product risks. These stories ignore the report’s important explanation that definitive evidence is not attainable and lack of human evidence of harm doesn’t mean something is safe.

From original NYTimes story on the report:

The report, 364 pages long and two years in the making, was issued on Wednesday by the Institute of Medicine, an independent group that is part of the National Academy of Sciences and advises the government and public. The work was done by a committee of 15 outside experts, mostly from universities, and nine institute staff members. The sole sponsor was a breast cancer advocacy group, Susan G. Komen for the Cure, which requested the report and spent $1 million on it.

For women who were hoping for definitive safety information about the huge number of chemicals to which people are exposed — from air pollution and cosmetics to cleaning products, food and drinking water — the report may come as a disappointment. It is based largely on a review of existing research, and its limited advice reflects the lack of solid scientific information in many areas of concern to the public.

Women should take note on Cape Cod, where the breast cancer rate is higher than average.  The Silent Spring Institute, one of the few groups doing research on environmental links to breast cancer, recently reporting finding 27 chemicals in well water on the Cape.

The 27 contaminants detected included 12 pharmaceuticals (the most common being one antibiotic and one epilepsy drug); five perfluorinated chemicals (found in non-stick and stain-resistant household products); four flame retardants; two hormones; one skin care product; one artificial sweetener; one insect repellent; and one plastics additive. Health-based guideline values were available for only four detected chemicals (PFOS, PFBS, DEET, carbamazepine), and no samples approached or exceeded these values. The most frequently detected chemical was acesulfame, an artificial sweetener, which was found in 85 percent of wells, and perfluorinated chemicals were detected in 70 percent of wells.

“While the levels of pharmaceuticals, flame retardants, and other emerging contaminants in drinking water are not currently regulated, we still think that it is prudent to find ways to prevent discharges from septic systems and wastewater treatment plants from impacting drinking water supplies, as we don’t fully understand the potential health impacts,” lead investigator Laurel Schaider said.

For more on health and the Massachusetts environment see  SSI or the Massachusetts Environmental Public Health Tracking (MA EPHT) Program Website

This website is designed to provide you with access to current and accurate health and environmental information available for Massachusetts. You can use Massachusetts Environmental Public Health Tracking (MA EPHT) information to learn about the health of your community and access information about your environment.