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Questions on DCIS surgery, libraries as havens for homeless, and role of social media in trials?

August 27, 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 section at the bottom of this page.

 

Features:

 

“In medicine we have a tendency to get too enthusiastic about a technique and overuse it. This has happened with the treatment of DCIS,” said Otis Brawley, MD, chief medical officer at the American Cancer Society. Brawley, in The New York Times, refers to ductal carcinoma in situ, or stage 0 breast “cancer,” a condition revisited this week by way of a newly released study published in JAMA Oncology. As many as 60,000 women hear the diagnosis each year and many opt for a lumpectomy or a mastectomy. The study, involving 100,000 women, concluded that treatment beyond a lumpectomy didn’t affect survival. The study was not the final word on DCIS as it was not a randomized controlled trial, but it once again heightens the debate around whether thousands of women are undergoing aggressive treatments—often disfiguring—for premalignant conditions that are not life-threatening. Some physicians have felt that DCIS should not even be labeled cancer.  In Vox, Gilbert Welch, MD, professor of medicine at Dartmouth, asserts “DCIS is probably best viewed not as a cancer, but as a risk factor for cancer—and not a terribly strong one. It’s nothing like smoking in lung cancer or the BRCA mutation in ovarian and breast cancer,” he said. The incidence of DCIS has increased sharply with the increase rates of breast cancer screening, and now accounts for some 25 percent of all diagnoses made by mammography.

 

We’ve written before that many homeless people suffer from debilitating mental illnesses, some ending up wrongly incarcerated. According to an article in the Washington Post, public libraries are becoming resources for the homeless during the day, when shelters are not available to them. Many of the homeless come to seek warmth in the winter, use the restroom or simply read. The American Library Association has formed a Hunger, Homeless, and Poverty Task Force to help library staff learn ways to help serve this population. One librarian notes of a homeless patron, “They can always come here, to be warm, safe, and entertained. At first, I didn’t know how important the library is to them, but one day before a holiday, a patron came up to me and said, ‘You guys will really be missed tomorrow.’” Until our society addresses adequate resources for the homeless and mentally ill, libraries (and prisons) will continue to serve as backup havens and warehouses.

 

After a motorcycle accident left her paralyzed from the chest down, Jesi Stracham enrolled in a clinical trial of a “Neuro-Spinal Scaffold” developed by InVivo Therapeutics, The Boston Globe reports. She was the second person to receive the device, and during her recovery has taken to social media to find support and document her progress. Her posts may have had an even further reach than originally intended, however. InVivo Therapeutics investors began scrutinizing Stracham’s every post. Real-time updates on the progress of Stracham and other patients provide both investors and scientists with a new form of data that offer insights into the function and potential of the device. After Stracham shared on her GoFundMe page that she was able to move her leg on her own, the company’s stock price coincidentally jumped 14 percent in one day. But the fact that Stracham holds shares of InVivo stock has called into question the veracity of her posts and whether the device is actually linked to her progress. Stracham’s story demonstrates that social media can give patients a louder voice and a useful venue through which to share and obtain information about their health.

But what role should patients’ posts on social media play in the development and marketing of drugs and devices in trial? We would like to hear your thoughts; please post them in the comments section below. 

 

Announcements:

 

  • Want to submit an activity for RightCare Action Week? Here’s one from a clinician, posted on the RCAW Forum: Take a very detailed social history for your patient, strip it of patient identifiers, and post it to highlight the importance of social determinants of health. Check out all the Forum ideas here: RightCare Action Week.

 

Headlines:

 

Overuse/overdiagnosis

 

Cost of care

 

Pharma

 

Hospital mergers

 

Elder care

 

End-of-life care

 

Social determinants

 

Practice

 

Culture of medicine

 

Public health

 

Telemedicine

 

Flibanserin

 

Pain medication/addiction

 

Med ed

 

Research

 

Medicaid

 

Primary care

 

Conflict of interest

 

Community health centers

 

 

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