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‘Revolving doors’ at the FDA, reducing care disparities, and more on RCAW

September 29, 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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A recent article in BMJ suggests that a substantial proportion of FDA medical reviewers are going through the ‘revolving door’— leaving the FDA to work for companies they previously regulated. According to Jeffrey Bien, MD and Vinay Presad, MD, MPH, a member of the Right Care Alliance Science and Evidence Council, more than half of the FDA’s reviewers of blood disease medications who left the agency after 2001 subsequently worked or consulted for the pharmaceutical industry. An additional 30% of reviewers’ succeeding jobs could not be ascertained, so the number of reviewers going through the ‘revolving door’ is likely to be even larger. While there is no law against former reviewers going to work for industry, there’s ample reason to worry that reviewers anticipating their next job (which will be far more lucrative than government work) may be biased in favor of their future employer when it comes to the drug approval process. As pharmaceutical companies present drugs for approval with less and less evidence, conflicts of interest such as the ‘revolving door’ are even more threatening to patient safety.

Neighborhoods have a powerful influence on health, according to Prabhjot Singh, MD, in a first person piece in this week’s STAT. Singh writes about his patient, Ray, who was born in the disadvantaged neighborhood of East Harlem and contrasts his situation to a person born in affluent Manhattan’s Upper East Side—with a difference in life expectancy of 10 years. Crumbling infrastructures, crime, street drugs, and access to poor diet in Ray’s neighborhood contributed to his poor health. For patients like Ray, writes Singh, providing the best clinical care is not enough to reduce disparities in health. “Rather than focusing on clinical diagnoses and treatments, we need to collaborate with community leaders and organizations providing social services, making ourselves part of the neighborhoods we serve.” Home visits are one means of integrating clinical medicine with community health. An article in The New York Times this week featured Thomas Cornwell, MD, a speaker at this year’s Lown Institute Annual Meeting, who has made more than 32,000 home visits to sick patients in his Chicago practice. Home visits may be making a comeback, thanks to portable technology, such as x-rays and EKGs. Cornwell advocates a Medicare payment model that would share savings from reduced hospitalizations that routinely result when physicians provide home services.

Susan Wright, PhD, from Marin County, CA, knows firsthand how important it is for health professionals to listen to patients. Two years ago, Wright was hit with chest pain, but was sent home from the emergency room when the doctors concluded she was not having a heart attack. When she returned, insisting that something was seriously wrong, they listened to her — only to discover she had a tumor just below her heart. During subsequent hospitalizations, she was subjected to numerous tests and procedures without her input. She frequently told her doctors that she had already had a certain procedure, and tried to relate important details about her medical history, her words often falling on deaf ears. Wright translated her frustration into action by practicing self-care and creating an advocacy group, Patients for Change. For Right Care Action Week, Wright will be representing both the Right Care Alliance and Patients for Change at the Marin County Senior Health Information Fair. Some 5,000 people are expected and they will participate in listening booths and writing responses to “What Worries You” cards. Wright is excited for the opportunity to reach so many people and promote right care through patient organizing. “There are millions of us, but we need to organize,” said Wright. Learn more about Right Care Action Week and sign up for your own event here!

Headlines

Overuse

Safety

End of life

Pharma

Clinician health

Doctor-patient communication

Access

Health care models

Patient engagement

Disparities

Public health

Cost of care

EHR

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

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