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Reactions to Trump’s HHS secretary pick, a review of overuse research, and a whistle-blower speaks out

December 1, 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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Donald Trump ran for president promising to fix the problems in American health care. He railed against inadequate, unaffordable coverage, restricted choice of care providers, and poor-quality care. And much of the public agrees with his assessment. However, the plurality of Americans want to replace the ACA with more comprehensive and universal coverage, not less. This includes many of Trump’s supporters, especially people in the areas hit hardest by the opioid abuse epidemic. There are opportunities to make real improvements in care across the nation, especially in the many hard-hit communities that are home to his political supporters, and we would applaud any movement the Trump administration made in that direction.

However, the nomination of Rep. Tom Price to be Secretary of Health and Human Services appears to be a step in the opposite direction. Based on ACA replacement legislation he wrote, Price is committed to scrapping many health insurance regulations, and to doing away with the subsidies that have made insurance affordable for millions of lower-income Americans. Perhaps he believes the theory that eliminating subsidies gives patients more “skin in the game,” and that removing benefit mandates and other regulations will allow insurers to offer better insurance products for their customers. This ignores decades of experience showing that rather than constraining costs, unregulated insurance markets become a race to the bottom: a competition between insurers to sign up healthy people, while leaving millions of middle class and poor people financially vulnerable to unexpected illness.

Price is also a member of an anti-science fringe group, the AAPS, which declares in its statement of principles that it is “evil” and “immoral” for physicians to participate in Medicare and Medicaid. It’s therefore disappointing that the American Medical Association (AMA) was so quick to support Price’s nomination, given the impact his stated policy preferences would have on patients. While the AMA supported the ACA when it was enacted, the organization, the nation’s largest professional organization for physicians, now seems to share Price’s rosy perception of the distant past, where the government stayed out of doctors’ business, and damn the consequences for patients. (Since this is the same organization that opposed the creation of Medicare 50 years ago, perhaps no one should be surprised.)

If enacted without major modifications, Price’s plan will sorely disappoint millions of Trump’s voters, and it will do real damage to the health of people and to the economic viability of communities across the country. We should not stand aside and let that happen in exchange for false promises of greater autonomy for physicians. We need to continue to fight for safe, effective, and affordable health care for everyone.

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After many years of neglect, research on medical overuse has begun to explode, with the number of articles on the topic nearly doubling from 2014 to 2015. While the number of articles indicates a growing awareness of overuse as a problem that must be addressed, it also makes keeping up with the latest findings more difficult for interested clinicians, researchers and patients. Fortunately, Lown Institute research symposium committee members Daniel J. Morgan, MD, MS and Deborah Korenstein, MD and colleagues have conducted a systematic review of research on medical overuse, identifying the most important studies published in 2015. This was no small feat. Writing in JAMA Internal Medicine, the authors reviewed more than 800 medical overuse articles and narrowed them down to the ten most influential papers. In these ten articles they found disturbing patterns of overuse, including a doubling of specialty referrals and advanced imaging for simple headaches from 2000 to 2010, overly frequent colonoscopy screenings, and an extremely high rate of testosterone replacement therapy.

***

When a company puts patients at risk by hiding data, can the ineffectiveness of its product really be considered a trade secret? That appears to be the position taken by blood-test start-up Theranos after a young employee blew the whistle, reports The Wall Street Journal. Less than a year into his employment at Theranos, Tyler Shultz, the grandson of political eminence and then-Theranos board member George Schultz, discovered that the company was manipulating its quality control testing. CEO Elizabeth Holmes had promoted the power of the company’s technology to test for multiple diseases using a finger prick’s worth of blood, and she became the world’s youngest self-made female billionaire, according to Vanity Fair. Under pressure from Theranos to stay away from regulators and the media, Schultz said, “I refuse to allow bullying, intimidation and threat of legal action to take away my First Amendment right to speak out against wrongdoing.”

Announcements

We are excited to announce that Jeffrey A. Sachs, PhD will be a keynote speaker at the annual Lown Conference, May 5-7, 2017 in Boston. Sachs is a world-renowned development economist and the former director of work on the UN’s Millennium Development Goals. His work touches on the intersections of poverty and health around the globe. He joins Patty Gabow, MD, MACP, former CEO of Denver Health and author of The Lean Prescription: Powerful Medicine for Our Ailing Healthcare System, on a growing list of thought-provoking Lown conference speakers. Learn more about the conference and registration here. Our conference media partner is STAT News. And there’s still time to submit abstracts for our research symposium and proposals for workshops – the deadline for both is December 18!

Headlines

Overuse

21st Century Cures Act

Access

Aging

Caregiving

Cost of care

Disparities

Doctor-patient communication

Ethics

Evidence

FDA

Model of care

Nursing

Organizing

Pharma

Public health

Social determinants

Women’s health

 

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