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‘Goldilocks’ care in hospital medicine, 4,000% overnight drug price increase, and work-family policy is a health issue

September 24, 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:

Patient advocate, writer, and RightCare Alliance member Casey Quinlan recently interviewed three pediatric hospitalists, all members of the RightCare Alliance Pediatrics Council, about providing the right care in hospital medicine. In this podcast for The HospitalistQuinlan defines right care as “Goldilocks medicine—not too much, not too little.” Shawn Ralston, MD, of Dartmouth-Hitchcock Medical Center, explained that it’s not immediately apparent to patients and families why they should be concerned about getting the right care; they assume that all the care they receive in the hospital will be necessary. Ralston and colleagues Ricardo Quiñonez, MD, of San Antonio Children’s Hospital, and Alan Schroeder, MD, of Santa Clara Valley Medical Center, all stressed that doctors need to do a better job of communicating with patients and families. Quiñonez says, “Ample evidence suggests that physicians are very quick to point out the benefits [of a treatment or test] to patients, but are not usually very cognizant about adequately pointing out the harms.” This needs to change, the three argue, especially when it comes to antibiotic stewardship. The RightCare Alliance Pediatrics Council is urging pediatricians to count the number of times they avoid an unnecessary antibiotic prescription for RightCare Action Week.

 

Just when you think you’ve heard it all about the runaway costs of prescription drugs in the U.S., this week we learn of an outrageous price spike of more than 4,000 percent. The drug, pyrimethamine (Daraprim), has been successfully used for six decades to treat toxoplasmosis, a parasitic infection. After Daraprim was acquired by Turing Pharmaceuticals, a start-up founded by 32-year-old former hedge fund manager Martin Shkreli, the price rose from $13.50 to $750 a pill, writes The New York Times. Average yearly cost to patients? More than $600,000, according to The Washington Post. When public outrage bubbled over in blogs and twitter, Shkreli defended the move, citing the need to fund future R&D and insisting the drug had not been profitable previously. Uwe Reinhardt, PhD, a health economist from Princeton, fired back in the Post piece. “He bought this patent and he’s milking it for all it’s worth. In a way, I thank him, because it’s really sort of like putting a sign on your back saying, ‘Kick me.’ Sometimes you need some sentinel effect that wakes people up.” And indeed this sentinel effect did. On Tuesday evening, Shkreli caved in to pressure and announced that he’ll reduce the drug price, to break even, or to “make a small profit.”  How much lower he’ll go is unclear. Shkreli’s company is not alone in milking the profits. Another, more commonly used drug, the antibiotic Doxycycline, priced at $20 a bottle in 2013, last year jumped to a whopping $1,849.

 

Anne-Marie Slaughter, President and CEO of the New America Foundation, writes in her new book, Unfinished Business: Women Men Work Family, excerpted in The New York Times, that long workdays and stressful work environments are so much the norm now that many experts are calling stress an epidemic. Unfortunately, Slaughter explains, the current culture of overwork leaves little room for caregiving, and as a result “we hemorrhage talent and hollow out our society.” The link between health and work-family policy is of particular importance for the 42 million women in America on the brink of poverty, when missing a day of work to care for a sick member of the family often puts their jobs at risk. While “our workplaces do not fit the reality of our lives,” recent policies and political pronouncements hint that we are slowly moving toward change. Both the current administration and 2016 presidential candidates have made policies that support working families (particularly high-quality child care) a major focus. In a Times Q&A, a reader asks Slaughter how individuals might combat this pervasive toxicity at work. Slaughter responds, “We have to harness the power of citizens to make our voices heard!” The power of healthcare professionals in the RightCare Alliance and other groups can add to the chorus.

 

Announcements: 

  • A regional RightCare Alliance meeting will be held in conjunction with the 2015 Family Medicine Education Consortium’s The Best Care Possible: The Right Care–Right Now–Getting Involved for Better Health, on Thursday, October 29, 8:30 am to 5 pm at the DoubleTree by Hilton and CoCo Key WaterPark Boston North Shore, in Danvers, MA. Meeting leaders include Alan Roth, DO, chair, Department of Family Medicine, Jamaica Hospital Medical Center; Vikas Saini, MD, president of the Lown Institute and Shannon Brownlee, MSc, senior vice president of the Lown Institute. The event is targeted to healthcare  professionals, policy makers, administrators and staff interested in improving healthcare delivery and health profession education systems. Learn more and register.

 

  • During RightCare Action Week (Oct 18-24), people across the country will be holding RightCare Story Slams. A Story Slam is a storytelling event that gives providers and patients a space to share their stories with a broad audience in order to build community around the unique narratives that exist in healthcare. If you’re interested in joining or hosting a RightCare Story Slam, please e-mail Paul Williams, pwilliams@LownInstitute.org.

 

  • To recognize National Primary Care Week this October, Primary Care Progress, in partnership with the American Academy of Family Physicians’ Family Medicine Interest Group, will host a webinar, titled Change Makers in Health Care, on Tuesday, October 13, 7 pm ET.  Hear from Shannon Brownlee, MSc, senior vice president of the Lown Institute and Glen Stream, MD, a family physician from La Quinta, CA. Learn more and register here.

 

  • The Society for Improved Diagnosis will hold a free public session empowering patients in the diagnostic process at its 8th Annual Diagnostic Error in Medicine Conference, this Saturday, September 26, 1-5:30 pm at the Hilton Alexandria Mark Center in Alexandria, VA.  For details, please see here.

 

Headlines:

 

Overdiagnosis/overtreatment

 

Mental health

 

Elder care

 

Pharma

 

Opioid abuse

 

Safety

 

Social determinants

 

Conflict of interest

 

Patient perspective

 

Research

 

Tech & innovation

 

Nursing

 

Access

 

Global health

 

Med ed

 

Cost of care

 

Spirituality

 

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

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