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Your favorites of 2014, community health in DC, and dubious use of diabetes drugs

January 8, 2015

Welcome back!

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

Join the conversation: Post your comments in our new section at the bottom of this page.

 

Features:

 

  • District of Columbia Acting Insurance Commissioner Chester McPherson signed an order this week for CareFirst Blue Cross BlueShield to spend $56 million on community health needs in the District after it was noted that its reserve holdings belonging to a subsidiary went well beyond what is considered a hedge against possible catastrophes. In a Washington Post article, the subsidiary, chartered as a benevolent institution, will now be required to turn over the excess to the community. The holdings, valued at more than $900 million at the end of 2011, the year in review, went beyond the appropriate reserve level by more than $250 million. Possible uses for the surplus include premium reductions for policy holders, direct funding for community health programs and corporate sponsorship of health-related events. Efforts like reallocating dollars into tangible benefits that keep communities healthy are extremely wise.

 

  • Expanding the definition of type 2 diabetes and pre-diabetes since 1997 has placed millions more Americans on drugs, many to lower blood sugar levels. But none of the dozens of new drugs available have been proven to improve key outcomes, like reducing heart attacks or strokes. Instead, they were approved by the FDA because they lower blood sugar levels, which is considered a surrogate endpoint. In an article by the Journal Sentinel and MedPage Today, the authors assert many of the drugs not only have questionable benefits, but also some are dangerous. “We’ve called a sign of the disease the disease, but there are no rigorous studies that prove we understand how to treat the illness rather than its symptoms,” said David Newman, MD, director of clinical research, Mt. Sinai School of Medicine, Dept. of Emergency Medicine, and a Lown Institute advisory board member. Several experts who serve on panels advising companies that make diabetes drugs were paid handsomely as speakers or consultants, the article concludes. Could that have something to do with the convergence of new drugs and definitions?

 

QUESTION: Should physicians with financial ties to drug companies be allowed to serve on specialty society guideline committees? Please tell us your thoughts in the comments section below.

 

In memoriam

We mourn the loss of Thomas B. Graboys, MD, president emeritus of the Lown Institute and former director of the Lown Cardiovascular Center, who died on January 5. Dr. Graboys was an exceptional, kind and generous physician, loved by all his patients and colleagues. Our deepest condolences to his family.

 

Headlines:

 

End-of-life care

  1. Rural Doctor Launches Startup to Ease Pain of Dying Patients – April Dembrosky, NPR
  2. As Caregiving Shifts to the Home, Scrutiny is Lacking – Anna Groman, Kaiser Health News
  3. Dying and Profits – Peter Whoriskey and Dan Keating, The Washington Post
  4. Can We Talk About Death? – Joanna Weiss, Boston Globe
  5. Doctors in Massachusetts Now Required to Offer End-of-Life Counseling – Martha Bebinger, WBUR
  6. Too Little, Too Late for Many New Yorkers Seeking Hospice – Fred Mogul, WNYC

 

Medicare/Medicaid

  1. Do No Harm? It May Be Hard to Avoid With Health Law’s Medicare Cuts – Austin Frakt, The Upshot
  2. As Medicaid Rolls Swell, Cuts in Payments to Doctors Threaten Access to Care – Robert Pear, New York Times

 

Practice Model

  1. The Army is Building an Algorithm to Prevent Suicide – Andrew Flowers, FiveThirtyEight
  2. Tending to Unmet Dental Needs, a Root of Elder Hunger – Colleen Wilson, The Wall Street Journal
  3. Rx for Reform: NC Pharmacists Try to Boost Health and Cut Costs – Ann Doss Helms and Jay Hancock, Kaiser Health News

 

Medical Education

  1. What Wasn’t Taught – Grace Farris, MD, Annals of Internal Medicine
  2. A Prescription for Better Teaching, Stronger Doctors – James Morris, WBUR
  3. A Shortage of Juggling Doctors – Abigail Zuger, MD, New York Times
  4. Continuing Medical Education Payments to Physicians Will Be Exposed to Sunshine – Larry Husten, Forbes

 

Medical Culture

  1. My Moral Distress: A Follow-Up Regarding Forced Futile Care – Dr. Jessica Ott, Earth Citizens’ Health and Wellbeing
  2. Wonder Abides, Even for a Skeptical Doctor – John Hening Schumann, WBUR
  3. Preventing Burnout in Doctors, Young and Old – Whitney L.J. Howell, North Carolina Health News
  4. Life-and-Death Decisions that Keep Doctors Up at Night – Shelly Reese, Medscape

 

Doctor-Patient Relationship

  1. Doctor, Shut Up and Listen – Nirmal Joshi, The New York Times
  2. Responses to Doctor, Shut Up and Listen
  3. Boundary Crossing: When Doctors And Patients Get Personal for Better Health – Dr. Annie Brewster and Jonathan Adler, WBUR
  4. Rediscovering Medical Professionalism – Dr. Martin Samuels, Forbes

 

Patient Safety

  1. Protecting Yourself from Over-Medication – Allen Frances, MD, YouTube
  2. A Tactic Worthy of Used Car Salesmen – Paul Levy, Not Running a Hospital
  3. An Attending Threatens Patient Safety. A Resident Blows the Whistle – Anonymous, KevinMD
  4. Hyperbaric Oxygen Therapy Gets More Popular as Unapproved Treatment – Joseph Walker, The Wall Street Journal
  5. Patients’ Expectations of the Benefits and Harms of Treatments, Screening, and Tests – Tammy C. Hoffmann, PhD and Chris DelMar, MD, FRACGP, JAMA Internal Medicine

 

Telemedicine

  1. Cautious Doctors Use Telemedicine to Diagnose Flu – Sydney Lupkin, Yahoo! News
  2. Paying for Telemedicine – Robert Rudin, PhD, David Auerbach, PhD, Mikhail Zaydman, BS, Ateev Mehrotra, MD, AJMC.com

 

Cost of care

  1. Dilemma Over Deductibles: Costs Crippling Middle Class – Laura Ungar and Jayne O’Donnell, USA Today
  2. How the High Cost of Medical Care is Affecting Americans – Elisabeth Rosenthal, The New York Times

 

RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation