May 11, 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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Last weekend, more than 270 clinicians, patients, health professionals, and others gathered in Boston, MA for the Lown Institute Conference. Attendees spent three days absorbing research, learning new skills, and engaging in strategic organizing around right care. Congrats to the “Best Abstract” winner, Lauren Taylor, MD, our “Best Student Abstract” winner, Jean Pannikottu, and our Right Care Vignette Award winners, one of which is now published in JAMA Internal Medicine. And in case you missed it, here’s Lown Institute President Vikas Saini’s Saturday closing speech from Saturday afternoon. Our key takeaways? We will never achieve right care without addressing social determinants of health, calling out corruption when we see it, and coming together in collective action.
The conference came not a moment too soon, as the US House of Representatives voted for the American Health Care Act, which would partially repeal the Affordable Care Act. In response to the new legislation, the Steering Committee of the Right Care Alliance released a statement at the Conference: “By removing protections for people with preexisting conditions and reducing federal support for Medicaid, the bill ensures that millions of people will lose coverage, and many will die. This is unworthy of a great nation.” In The Huffington Post, two doctors concur with the Steering Committee, arguing that we’re all in it together when it comes to health. “Health policy that treats individual as island is a recipe for failure. No one, rich or poor, lives in a vacuum insulated from disease,” they write.
At the Lown Conference last weekend, keynote speaker Patty Gabow, MD, MACP said, “We don’t need more free-standing Emergency Departments. We need to invest in the social system if we want to improve health.” This week, a new study in JAMA lends further evidence to the importance of social determinants of health, by examining age-specific trends in geographic health inequalities on a county level. Researchers found that disparities in life expectancy at birth have increased over the past few decades, to as much as a 20 year difference between certain counties in the US. While the gap appears to be decreasing for children and adolescents, it is widening for adults. Differences in socioeconomic status and race explain much of this life expectancy gap because of the correlation between these factors and certain health behaviors and outcomes, their analysis shows.
In case you didn’t get enough discussion of conflicts of interest from Ralph Weiss’ patient story and the Corruption and Patient Harm panel at the Lown Conference, check out this in-depth series on conflicts of interest in JAMA. The series includes more than 20 research and opinion pieces on conflicts of interest in medical schools, medical journals, biomedical research, and more. A few key insights: doctors are more likely to prescribe generic rather than brand name drugs when visits from drug reps are restricted; even small payments from drug companies can create bias; and a “potential” conflict of interest still has ethical implications.
The push for conditional approval of new cancer drugs by the FDA after Phase I trials is a threat to patient safety and a waste of money, writes Shannon Brownlee in CollabRX. Proponents of conditional approval (such as Scott Gottlieb, the newly approved FDA commissioner) argue that Phase III clinical trials are slow and expensive, and that patients should have the right to use drugs that prove safe in early trials. However, many drugs approved by the FDA —almost a third, according to a recent study—are later found to pose safety risks to patients, even after passing through Phase III trials. Even more importantly, another study in The BMJ found that 35% of approvals made on the basis of one pivotal trial had no follow-up studies completed five years later. In a conditional approval system, post-market studies are the only mechanism for guaranteeing that drugs are really safe and effective, so that poor track record should be cause for hesitation amid the conditional approval crowd.
Mark your calendars for Right Care Action Week 2017 – October 15-21. More details on RCAW to come!
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Right Care 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.