Overuse neglected in performance measures, Coca-Cola COI, and ‘truth’ in pharma marketing

August 20th, 2015

August 20, 2015

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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Erika H. Newton, MD, MPH, and colleagues published a study in JAMA Internal Medicine this month that probed the extent to which outpatient and emergency department clinical performance measures assessed underuse as compared to overuse. In an interview with MedicalResearch.com, Dr. Newton underscores the growing concern that if performance measures are too narrowly focused on underuse, this will lead to excessive unnecessary care. And yet process measures overwhelmingly target underuse. Examining 16 major national collections of performance measures, the authors found that out of a total of 521 outpatient measures, more than 90 percent assessed underuse, while only seven percent assessed overuse. And the overuse measures in this seven percent were not widely employed— almost half included none at all. To solve this issue, the authors recommend that clinicians both consider the evidence, but also engage with the system to help reshape policies and begin to address the “’more is better’ culture in medicine.” Stephen Martin, MD, and Jerome Hoffman, MD, advise in a USA Today piece that patients can also play a role in recognizing and avoiding unnecessary care.


The Global Energy Balance Network, a new not-for-profit focused on issues around inactivity, poor nutrition and obesity, claims in a recent video that there is limited evidence that consumption of fast food and sugary beverages are the cause of overweight and obesity. GEBN scientists assert it’s all about balancing energy intake (diet) with energy expenditure (exercise). While at first blush this might sound reasonable, the strong body of evidence demonstrating the important role of dietary intake, paired with the organization’s blatant conflict of interest, calls their message into question. Anahad O’Connor of The New York Times reports that Coca-Cola has donated millions of dollars to GEBN and its affiliates over the past seven years, and that Coca-Cola holds both the registration and administrator privileges to the GEBN website. Michael F. Jacobson, PhD, president of the Center for Science in the Public Interest, and Walter Willett, MD, professor and chairman of the department of nutrition, Harvard T. H. Chan School of Public Health, assert in another Times piece “the scientific nonsense peddled by the Coca-Cola-funded Global Energy Balance Network is outrageous.” Experts say it is no surprise that as Coca-Cola sales decline and policymakers and the public are becoming more health conscious, Coke is trying to deflect concerns its products harm health. Unfortunately for them it will be an uphill climb.


Earlier this month, a federal judge in New York preliminarily found for Amarin Corp., a pharmaceutical company, allowing it to “to engage in truthful and non-misleading speech promoting the off-label use” of its cardiovascular health drug, Vascepa. The drug had previously been approved by the FDA only for patients with severely elevated triglyceride levels, but Amarin sought to promote it for patients with lesser levels—which would, of course, boost profits. In articles in The New York Times, LA Times and Washington Post, Judge Paul Engelmayer cited free speech under the First Amendment, which he said protects drug companies making truthful statements about their drugs, even those for unapproved use. The word “truthful” is key because it remains unclear who or what body would be responsible for validating truthfulness claims. The FDA may appeal the decision but in the interim, we wonder how many other pharmaceutical companies have been inspired by this decision. Ironically, the court decision came on the day that stalwart FDA scientist Frances Oldham Kelsey died. In a blog, Shannon Brownlee, MSc, Lown Institute Senior Vice President, praised Kelsey for preventing thalidomide, a drug known for causing birth defects, from being marketed in the United States.



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RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.