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Improving the end of life, Sovaldi oversold, and advice for a new Governor

January 15, 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.

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

 

Features:

In a Boston Globe op-ed, Angelo Volandes, MD, describes the deep failures in American end-of-life care, through his experiences as a physician and his research on helping patients make more informed treatment decisions. By using videos, patients can get a much better understanding of what different end-of-life treatment options, including CPR, intubation, and hospice care, will look and feel like. Dr. Volandes’s new book, The Conversation, expands on the importance of end-of-life decision-making through more stories, and argues that ultimately, rethinking the doctor-patient relationship is essential to helping patients make the best decisions for them.

 

A new paper in The BMJ, with authors including Jeanne Lenzer and John Ioannidis, MD, takes reporters and physicians to task for overstating the importance of new hepatitis C drugs like sofosbuvir (Sovaldi). The authors point out that while large numbers of people are infected with hepatitis C virus (HCV) and the consequences of hepatitis C can be severe, many people infected with HCV don’t ever develop serious liver disease. Given that, and the substantial side effects caused by drugs like sofosbuvir, which have been downplayed by the manufacturer and in the press, it may not be worth pursuing aggressive screening and treatment for people who are unlikely to have serious symptoms. Moreover, saying the drug offers a “cure,” as many press accounts have done, is premature: the benefits of new antiviral treatments have been oversold. Most of the clinical trials have showed benefits only in surrogate outcomes like levels of HCV in the blood, rather than in improving clinically meaningful patient outcomes.

 

As the new governor of Massachusetts comes into office, Lown Institute Vice President David Martin, recommends ways to reorient healthcare systems in the Bay State.  In his op-ed on WBUR’s ideas and opinion page, Cognoscenti, Martin advocates shifting healthcare models from incentivizing more care, to one of keeping people healthy by eliminating overtreatments, creating healthy communities and bolstering primary and preventive care. “Accountable Care Organizations, under which providers earn more if they keep their patients healthy, are a good start,” Martin says. “But before ACOs can devote money to the kinds of services that create healthy communities, they will have to root out the services that are overused and unnecessary. To do this, they will need the support and input of the community they serve.”

 

 

Announcements:

 

  • Overcoming the 7 Deadly Obstacles to Dying in Peace, a 3-part Webinar Series: End-of-life author and reformer Bart Windrum identifies, assesses, and helps mitigate prevalent obstacles to dying in peace. If you’ve had “the conversation” and executed advance directives, this program is your best next step. If not, this 3-part series in February is your best first step. This program focuses on the vast middle ground between advance planning and spiritual engagement. For more information, visit AxiomAction.com/webinar2015

 

  • Just a few hours left! Register for the 2015 Lown Conference by 5 pm Pacific time tonight to be entered to win a set of books on right care: Shannon Brownlee’s Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer and Dr. Bernard Lown’s The Lost Art of Healing, Prescription for Survival, and Practicing the Art while Mastering the Science. The books are a great way to prepare for the conference, or to start a conversation with your colleagues about the problem of overtreatment. Register now!

 

Question: We want to hear from you! What are you most looking forward to when you attend our third annual conference, coming up this March in San Diego?

 

Headlines:

Practice design and primary care

 

Overtreatment

 

Evidence-based medicine

 

Overdiagnosis

 

End-of-life care

 

Population health

 

Pharma

 

Shared decision making

 

Opioids

 

Payment system

 

Medical education

 

Patient safety

 

Tech

 

Hospital consolidation

 

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

 

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