Group aims to improve serious illness care, housing the homeless, and the wrong way to drug approvals

May 19, 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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Massachusetts has always been on the forefront of health care delivery, expanding access, for example, before other states have. Yet on end-of-life care, Massachusetts, like many other states, needs improvement, according to a report in The Boston Globe. A survey of the state’s residents, conducted by a new consortium composed of dozens of health care groups, has found that of respondents who had a relative die recently, a third said that the medical staff had not fully carried out the dying person’s wishes. Other survey findings: 85 percent believe physicians should discuss end-of-life desires with patients, but only 15 percent had; and 1 in 5 ranked their loved one’s care at the end as fair or poor. Len Fishman, of the Massachusetts Coalition for Serious Illness, said “a very natural human reaction, that is reinforced by the medical establishment, is to default to the most conservative thing—more treatment and intervention.” A task ahead for the Coalition and for other groups, including the Right Care Alliance, is to persuade more Americans that the truly conservative treatment choice is the one that well-informed patients and families prefer.

They tried in San Francisco, and it worked. Now they’re doing it in LA—using health funding to move the homeless into permanent housing. STAT reports that instead of using monies solely for medical treatments and hospitalizations, county officials are searching for available, affordable housing units, hoping to get 2,000 people in LA county housed within four years. The project is led by San Francisco alumni, Marc Trotz and Mitch Katz, MD and is praised by the U.S. Interagency Council on Homelessness. In addition, the county is boosting its health outreach efforts, assigning teams of nurses and other health care personnel to canvas Skid Row, where tents and boxes serve as shelters for thousands who are homeless. Katz, a Lown Institute Conference keynote speaker last year, often questions why society has chosen to treat the homeless often with expensive hospitalizations, but not provide them with housing, which he calls “the most effective service” for treating many of their health problems. A report in the Boston Herald this week finds that for homeless Bostonians, hospital stays are longer than that of an average patient with similarly debilitating physical illnesses. “You can’t discharge people as quickly when they live on the street as opposed to going back to a home where they may have someone to take care of them,” said Jessie Gaeta, MD, of the Boston Health Care for the Homeless Program.

Bill Frist and Tom Coburn, both physicians and former U.S. senators, insist the 21st Century Cures Act, which will provide millions more dollars for medical research, “will streamline the nation’s regulatory process for the discovery, development and delivery of safe and effective drugs and devices, bringing the process into the new century.” The Senate, they say, soon has a chance to vote, “to cut regulation and promote medical innovation,” their Wall Street Journal op-ed blares. Yes, billions more funds would be available for medical research if the Senate goes forward with the companion bill to the one passed by the House last year. But not so fast. The funds are tied to speedier FDA approvals of drugs and devices, by weakening regulatory rules. Speedier approvals, claim the bill’s proponents, are what Americans want. Yet a recent poll conducted by the Harvard T.H. Chan School of Public Health validates that more than half of the Americans polled oppose changing the standards for quicker approvals. Critics warn that weaker rules will lead to more drugs on the market that must eventually be removed when it is discovered that they harm patients. The real beneficiaries of faster rules are drug and device makers, and bundling faster FDA approval with more NIH funding is intended to win support from universities and small biotech companies.“ “Loosening regulatory standards would only create problems for which real cures will be needed,” STAT’s Ed Silverman concludes. We agree.


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