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Does cancer screening save lives?, housing is health care, and anti-abortion win in North Carolina

January 14, 2016

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.

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Features:

Many believe that screening for cancer saves lives. But do they really? In a study out this week in the BMJ, Vinay Prasad, MD, David Newman, MD and Jeanne Lenzer argue that this claim is based on disease-specific mortality, not overall mortality—which should be the benchmark against which screenings should be assessed. What studies of screening have not done, according to a piece in Time, “is show how people who get screened fare when it comes to dying from any cause compared to people who don’t get screened.” Moreover, many patients do not understand the downsides of screening, in part because advocates have emphasized potential benefits of screening without pointing to the harms of false positives, over-diagnosis, and the overtreatment that often follows. The BMJ authors encourage healthcare providers to be forthcoming about screening limitations and their potential harms. In a companion editorial, Gerd Gigerenzer adds “To prove that screening saves lives one needs to find a difference in overall mortality. Yet detecting such a difference, if it exists, with reasonable statistical power in the general population would require studies with millions of participants.” Communicating the pluses and minuses of screening would certainly help patients make better screening decisions. As Medicare considers penalizing physicians for ordering prostate-specific antigen tests because the case against them is strong, H. Gilbert Welch, MD and Peter Albertsen, MD, in The New York Times stress that screening must be an individual choice, nevertheless, and perhaps reimbursing providers for their time for fully informing patients of risks and benefits might help with shared decision-making.

 

In the most recent issue of Health Affairs, Bill J. Wright et al. write of the strong association between housing and health. Using Medicaid claims data and self-report retrospective surveys, investigators assessed health outcomes among 98 formerly homeless adults in Oregon. The study population had significant medical and psychosocial needs. The authors found that “the year after moving in, residents [of supportive housing] with Medicaid… saw an average annual reduction in Medicaid expenditures of $8,724.” A closer look at the data revealed that lower expenditures were primarily the result of decreased ED use, inpatient care, outpatient lab testing, and outpatient specialty care. At the same time, the use of primary care and outpatient behavioral health services increased. Wright and colleagues conclude that new health care strategies must be informed by the social determinants of health.

 

We don’t often write about abortion or other women’s health issues. It seems nearly every day lawmakers have passed one bill or another that chips away at the rights of women and the clinicians who care for them. But, as two Weekly readers reminded us last week, overtreatment, under-treatment, and mistreatment are rampant in reproductive health care, and this issue warrants significant attention. We agree, and in response the Right Care Alliance is discussing how to focus more attention on women’s health. In the news this week, the North Carolina legislature just passed a law requiring doctors who perform abortions after 16 weeks to provide state officials with a copy of the ultrasound. According to The New York Times, anti-abortion activists hope that this law will intimidate clinics and act as a deterrent to keep “doctors from lying about gestational age.” The law also extends the waiting period from 24 to 72 hours, and requires doctors who perform abortions past 20 weeks to provide evidence that a medical emergency necessitated the procedure.

 

Announcements:

  • Join us for the 4th Annual Lown Institute Conference at the JW Marriott Chicago, April 15-17. You will have plenty of opportunities to learn about right care, from attendees you’ll network with, and from our renowned speakers: Jeffrey Brenner, MD; Gordon Guyatt, MD; John Ioannidis, MD; Joanne Lynn, MD; and Rita Redberg, MD.  Register now before early bird registration closes. Space is limited.

 

  • We are pleased to offer the second annual RightCare Vignette Competition. We are seeking clinical vignettes written by trainees that describe harm or near harm caused by medical overuse. To learn more or to submit a vignette, visit our RightCare Vignette Competition page.

 

Headlines:

Overuse

 

End of life

 

Cost of care

 

Public health

 

Guns

 

Opioid crisis

 

Quality and safety

 

Bernard Lown

 

Practice

 

The business of health

 

Behavioral health

 

Family policy

 

 

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