Welcome to the RightCare Weekly, a newsletter that will help you stay on top of all the important news in the ongoing quest to move the U.S. health care system toward the right care. We’ll bring you the most important stories, news articles, and opinion pieces of the week, along with our interpretation of why they’re important and what they mean for patients, doctors, and communities.
“I don’t want Jenny to think I’m abandoning her.” Attendees of our last two conferences will recognize this story: Diane Meier, a palliative care physician, writes of her experience treating Jenny, a terminal cancer patient, and of the struggle Jenny’s oncologist faced in caring for her without over-treating her. Meier notes that many physicians find it difficult to express their caring for patients without ordering intense, and sometimes unnecessary, medical procedures. That emotional disconnect reflects the technical emphasis of physicians’ training, and the limited time available for developing personal relationships with patients and their families. The oncologist’s fear that Jenny would think he was “abandoning her” by stopping curative treatment – and the unnecessary, invasive treatment that almost resulted – shows the importance of relationships and communication for both patients and clinicians.
A panel of cancer experts argued this week in The Lancet for renaming some types of slow-growing conditions that are unlikely to cause harm if untreated. Melinda Beck of the Wall Street Journal writes that the proposed new name, “IDLE” (indolent lesions of epithelial origin), is important because for many patients and physicians, it’s difficult to even consider not treating something called “cancer.” Changing the way we talk about these conditions could help reduce overdiagnosis, make it easier for patients to understand the risks they face (and compare that with the possible harms of treatment), and reduce the anxiety that can lead to unnecessary follow-up testing and treatment.
In 2003, the large drugmaker Bayer asked the FDA to approve aspirin as a drug for primary prevention of heart attacks, arguing that studies suggested that a daily aspirin regimen could save lives even in people without heart disease. This week the FDA denied their request, based on evidence showing that while aspirin is useful in preventing second heart attacks in those who had already had them, for people without preexisting heart disease, the risk of harm from bleeding in the brain or stomach outweighs any benefit from heart attacks that are prevented.
The idea that statins are overused is not new, but this week, Roni Caryn Rabin on the NYT Well blog suggested that this problem may be even more serious for women. While studies of statins have enrolled far more male patients than female patients, women tend to develop heart disease later in life than men and stand to benefit less from reduced risk of heart attack. The story goes on to note that the side-effects of statin use can be serious and for young, healthy women those side-effects are not worth it for a treatment that offers almost no benefit.
Finally, we’ve writtenbefore about the evidence that screening mammograms have no proven mortality benefit, and could actually do more harm than good. Dr. Janice Boughton has written a good overview of that literature, incorporating two new articles, and shows once again that the benefits of screening for women at low risk are small, while the harms for those overdiagnosed can be substantial.