March 30, 2017
In order to bring you more of the news you want to read, Right Care Weekly presents articles related to moving our healthcare system toward the right care for all patients.
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Two years ago, Princeton economists Anne Case and Angus Deaton published a paper that rocked the world of economists and demographers. They found that life expectancy for middle-class, white, non-Hispanic Americans was falling, largely due to suicide, liver disease from alcohol, and drug overdoses. In a paper published this week, Case and Deaton argue that there are “two Americas,” divided not so much along political lines as education and the economic prospects it provides. Among white non-Hispanic Americans, “mortality is rising for those without [a college degree], and falling for those with a college degree,” they write. They hypothesize that declining labor market opportunities give this demographic group a “cumulative disadvantage” compared to their parents’ generation, which bleeds into non-economic aspects of their lives. “We are trying to say that low income and low job opportunities, after a long period of time, tears at the social fabric,” said Deaton in The Atlantic. “It’s the social fabric that keeps you from killing yourself.” (Some important caveats to Case & Deaton’s current paper are explored in this Slate article.)
A study in JAMA this week aimed to quantify the effects of advertising on patients’ treatment choices, by measuring rates of testosterone testing and supplementation in areas with and without television advertisements for testosterone treatment for “low T.” The authors found that each ad increased rates of testing and treatment in the regions where they aired. Even more disturbing, each advertisement increased the number of men who started testosterone treatment without first being tested for low testosterone. Speaking of dubious advertising, a STAT story gives an example of how marketing for an unproven “breakthrough” cancer therapy fell afoul of FDA regulations on promoting products that haven’t yet been shown to work.
In a WBUR commentary, Paul E. Sax, MD, professor at Harvard Medical School, weighs the upsides and downsides of letting first-year residents return to working 28-hour shifts. The rule reinstating 28-hour shifts was ostensibly justified by a single non-inferiority study that found no difference in patient mortality between hospitals where surgical interns were limited to 16-hour shifts, and others where they were allowed to work up to 28-hour shifts. Proponents of longer shifts have argued that they help interns see the course of illness in individual patients, and that longer shifts reduce the number of potentially risky hand-offs of care between providers. But as Sax points out, long hours can have devastating effects on clinician health (also see The Washington Post, KevinMD, and The Atlantic). He adds, “The long hours and fatigue could made us look at the patients not as the human beings we should be trying to help, but as components of assembly line work.”
Robert Whitaker writes in Mad in America about the debate surrounding the Norwegian Ministry of Health’s decision to create medication-free psychiatric wards. The order for medication-free wards was spurred by years of organizing by patient-led organizations and timely media coverage on psych ward conditions. Some psychiatrists remain skeptical, fearing that people with psychotic disorders will choose sub-optimal treatment plans. Advocates for the new wards frame the issue as one of patient choice. “We were used to saying to patients, ‘This is what is best for you,’” said Merete Astrup, director of the medication-free unit in Tromsø, Norway, “But we are now saying to them, ‘What do you really want?’”
Why do some programs to curb overuse stick, while others don’t? This week, in the first in our Conference Preview blog series, we spoke with Michael Parchman, MD, PhD and Brian Austin of the MacColl Center for Health Care Innovation to find out what they’ve learned in a year of intensive research on overuse initiatives. They found that “top-down crams”— initiatives forced on clinicians from the leadership—tend to work only in the short term. “What works better is having the front line bubble up ideas that are then supported by the leadership,” said Austin, “The leadership needs to give providers the tools, capacity, and the time to make this happen.” Read more about Taking Action on Overuse on their website, and don’t miss their hands-on workshop on May 6 at the Lown Conference.
Join us for the Lown Institute Conference, Beyond the Bottom Line: Defending the Human Connection in Health Care on May 5-7, 2017 in Boston, MA. Register now to learn about the newest research in right care, with nearly 50 abstracts, posters, and presentations on topics such as eliciting patient concerns, overuse of IV hypertensive medications, and the impact of black box warnings on medication formularies. This activity has been approved for AMA PRA Category 1 Credit™. This activity is awarded ANCC credit. See our conference info page for specific details.
Bad Science = Bad Medicine. Join Right Care Alliance Members across the country in marching for science on April 22! If you’d like to join a march or start one in your city, sign up on Facebook or contact firstname.lastname@example.org. And if you are marching in the Earth Day science march, don’t forget to order your t-shirts! The deadline for ordering t-shirts is March 31st.
Local single-payer advocacy groups in Massachusetts have organized a Rally to Take Back Health at Boston Medical Center on April 8, as part of a National Day of Action for Improved Medicare for All. If you want to join them check out the Facebook page here.
Conflicts of interest
Cost of care
End of life
RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.