CDC could (and should) fund more gun studies, mortgages for care costs?!, and weak NEJM conflict-of-interest policies

April 7, 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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Since JFK was shot and killed in 1963, more Americans have been killed by gun violence than were killed in all U.S. wars combined. The CDC was one of the first health agencies to study gun violence, publishing papers in the early 90s like Gun Ownership as a Risk Factor for Homicide in the Home (NEJM, 1993). Now the CDC won’t even acknowledge gun violence as a public health issue, says Linda Degutis, a former director of the CDC’s National Center for Injury Prevention and Control. The CDC is not funding studies; in fact, only $5 million is spent annually on gun studies. That’s half as much as one study on HIV or cancer can cost. Many blame the Dickey Amendment for blocking research on firearms deaths and injuries. But former CDC insiders including Degutis and Mark Rosenberg, a founder of the CDC’s Injury Center, are saying that the Dickey Amendment simply places constraints on studying gun violence, and that top CDC leadership is making the decision to limit gun studies out of fear of political retribution. “Right now,” says Rosenberg, “there is nothing stopping them from addressing this life-and-death national problem.” The CDC continues to claim lack of Congressional cooperation is the barrier. Yesterday “health care, public health, scientific organizations and research universities representing over 1 million members across the country” signed and sent a letter urging Congress to provide the CDC with funding “for research into the causes and prevention of gun violence.”


Last week we included the headline from Kaiser Health News: “Mortgages for Expensive Health Care? Some Experts Think It Can Work.” The article described a paper recently published in Science Translational Medicine that calls health care loans (HCLs)—the equivalent of mortgages for large health care expenses—“a practical way to increase drug affordability.” This week, we’re exploring Lambert Strether’s perspective in Naked Capitalism on why this idea is insane. Why is this idea insane? Because it will send treatment prices on an upward trajectory with no visible ceiling. The borrower has little ability to assess the value of the treatment to him or her, and no guarantee that it will actually deliver on its promise (this is what Strether calls “scope creep”). It makes possible “debt-cropping” (basically indentured servitude, described here in Naked Capitalism) and predatory servicing. And who sets the prices for these treatments today? The producers of the treatment. HCLs will only further perpetuate the business culture of medicine, moving us further and further away from the healing culture that medicine once offered.


“We’re not arrogant. We’re not dismissive,” said Jeffrey Drazen, MD, editor-in-chief of New England Journal of Medicine, in response to criticism that the time-honored publication has been receiving for its failure to correct errors and open up research. As reported in The Boston Globe this week, writer Charles Ornstein points to the publication’s loosening of its conflict of interest policy under Drazen, contrasting it to those of his predecessors. Also of concern is the Journal’s opposition to making available research data, which would allow others to analyze it, considered essential in advancing science. Brazenly, Drazen refers to those who seek such data openness as “research parasites.” Last May, a series of three articles in the Journal, written by Lisa Rosenbaum, MD, drew additional criticism from physicians and others, as the pieces questioned the reasoning behind conflicts of interest among researchers and clinicians. The Lown Institute denounced the series soon after they appeared with a special issue of this newsletter, and offered commentaries from Vikas Saini, MD, president; Shannon Brownlee, MSc, senior vice president; as well as from Vinay Prasad, MD, Roy Poses, MD, Larry Husten, MD, Susan Molchen, MD, and others. Given the vast criticism, will the Journal change its policies on COI? From the Globe piece it seems doubtful, with Drazen hinting he won’t.



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