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Evidence-absent medicine, Congress ties to big pharma, and concerning findings about senior cardiologists

RightCare Weekly
December 3, 2015

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:

Two opinions last month in The New York Times underscore how some scientifically debunked practices are still commonly performed in medicine, such as the use of antibiotics for ear infections or tube feeding for demented patients. Haider Javed Warraich, MD, writes that millions of elderly, demented patients are being fed by tubes that are painfully inserted, while there is no evidence for their benefit. In fact, tube feeding poses additional harms when tubes become clogged or dislodged. Warraich believes financial incentives might be at play, but more egregiously, he says, many physicians mistakenly believe tube feeding leads to improved survival rates. David Newman, MD, in his piece, insists that rigorous studies can discredit ill practices, and cites research authored by Vinay Prasad, MD, and Adam Cifu, MD. In Prasad’s view,  “The adoption of practices based on little or no good evidence is our biggest problem. If we decide to use new technologies while waiting for definitive studies, they should be labeled ‘experimental,’ and patients should be counseled appropriately.” Until that becomes standard practice, will it be up to patients to ask the right questions?

 

Members of Congress are not required to recuse themselves from voting on bills that could affect their personal finances,” reports STAT. The publication conducted an analysis of thousands of pages of congressional disclosure forms and found that 30 percent of senators and 20 percent of representatives had financial ties to biomedical or healthcare companies, including Pfizer, Johnson & Johnson, and Merck. Many of these investors hold positions that allow them to influence legislation in favor of these companies – in stark contrast to most federal employees who must recuse themselves from decisions on issues in which they may have financial interest. For example, Rep. Christopher Collins (R, NY) has pushed to pass bills and loosen requirements that would benefit companies in which he has invested heavily. Rep. Scott Peters (D, CA) has been named “elected official of the year” for his political battles on behalf of biomedical companies in his district. It’s no surprise, then, there is no political interest in stemming global tax avoidance in this sector, such as the $160 billion deal combining Pfizer and Allergan into one large company “technically headquartered in Ireland.” While this inverted company will continue to be protected by American securities and patent laws, its tax bill will be dramatically reduced, thus “shortchanging the public and robbing the Treasury of money that would pay for… education, scientific research, and other services,” reveals The New York Times.

 

What’s one way to make sure a patient has a good outcome after a heart attack? Admit him when the senior cardiologists are away at a national cardiology meeting. That’s the main finding of a study published earlier this year in JAMA IM and discussed this week by Ezekiel J. Emanuel, MD, in The New York Times. Anupam B. Jena, MD, PhD, and colleagues analyzed mortality and treatment differences among patients during dates of national cardiology meetings. The authors found that patients admitted for acute cardiovascular conditions had lower 30-day mortality when they were admitted during these dates as compared to non-meeting dates. Emanuel offers two potential explanations. One, the junior physicians left behind may be more adept clinically than the senior clinicians attending the meetings. Alternatively, when senior clinicians are around, patients are significantly more likely to receive more interventions that may not help (and likely harm) them. Emanuel goes on to cite numerous examples of the harms of overtreatment, suggesting “that studies show that when patients are systematically given information about benefits and risks, they tend to consent to fewer interventions and feel more informed about their decisions.” To elicit more information from your doctor, start with these five questions.

 

Announcements:

 

  • We’re happy to announce keynote speakers to date for the 4th Annual Lown Institute Conference, April 15-17, 2016 in Chicago.They are John P.A. Ioannidis, MD, Rita Redberg, MD and Gordon Guyatt, MD. Learn more about the conference and register here. Learn about conference scholarships here. And don’t forget, we are still accepting abstracts for Research Day to kick off the conference on April 15. Deadline for abstract submissions is December 15, 2015. For submission information, click here.

 

Headlines:

 

Overuse

 

Public health

 

Environmental health

 

Guns

 

Patient engagement

 

Transparency

 

Practice

 

Safety

 

End-of-life

 

Pharma

 

Cost

 

Tech & innovation

 

Screening

 

Med ed

 

Doctor-patient relationship

 

Conflict of interest

 

Access

 

Evidence-based medicine

 

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