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Surgeons address gun violence, evaluating a “breakthrough” drug, and more

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March 23, 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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In a recent JAMA Surgery viewpoint, Philadelphia trauma surgeons Jessica Beard, MD, MPH and Carrie A. Sims, MD, MS address an issue they deal with every day but often feel powerless to stop – gun violence. “When we save a patient in the operating room, we feel great, and yet despite our hard work the patients keep coming,” said Simms, a member of the Right Care Alliance Surgery and Perioperative Care Council. In Philadelphia, gun violence disproportionately affects people of color, but race is rarely mentioned in firearm injury research. Beard and Sims challenge their fellow surgeons to bring structural racism into the dialogue on gun violence and advocate for additional funding to research the root causes behind this racial disparity.

A new study on cholesterol-lowering drug Repatha (evolocumab, a PCSK9 inhibitor) came out this week, with some news outlets reporting “landmark” results. Not so fast, says Health News Review. In the study, Repatha reduced the relative risk of cardiovascular events by 15%, which seems impressive. But in absolute terms, the drug only reduced the rate of the primary composite endpoint by 1.5%, dropping the rate from 11.3% in the control group to 9.8% in the treatment group. Taking into account the drug’s steep price, that’s about $2 million for each prevented heart attack or stroke. “It’s a small reduction for a super expensive drug,” said John Mandrola, MD a cardiologist and RCA member in USA Today.

“The real source of our spending problem is not a nation of hypochondriacs, nor even the sickest five percent of Americans. It’s our sick health care system,” writes Lown Institute vice president Shannon Brownlee in the Washington Monthly. Brownlee introduces a series in The Monthly highlighting three innovative programs that provide right care at a lower cost – a San Diego pre-hospice program that helps elderly patients with chronic conditions stay out of the hospital, a coordinated care clinic for Stanford employees with multiple chronic conditions, and a Missouri health home that integrates mental and physical health care.

President Trump’s budget, released last Thursday, proposes drastic cuts to programs that affect public health, including Environmental Protection Agency initiatives, medical and science research, and training for health professionals. “This budget proposal presents a fiscal agenda that would undermine the health and well-being of Americans,” said Georges Benjamin, MD, executive director of the American Public Health Association, quoted in Modern Healthcare. Trump’s proposed budget would also cut grants that fund Meals on Wheels, which Aaron E. Carroll, MD, MS argues in The New York Times provides benefits beyond nutrition.

The Texas Medicaid program found an effective way to reduce unnecessary early induction of childbirth: Stop paying doctors to do it. Starting in 2011, the program has refused to pay providers for elective early deliveries, which contributed to a 14% reduction of these deliveries in the first two years, Kaiser Health News reports. The state’s average length of pregnancies and birth weight also increased during this time. In related news, a JAMA study finds that two popular types of screening are ineffective for reducing preterm births.

Announcements

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.

Join Right Care Alliance Members across the country in marching for science on Earth Day! Right Care Alliance groups in Boston, Washington DC, San Francisco, Chicago, St. Louis, St. Paul, San Jose, and Charlottesville will be marching in support of evidence-based medicine on April 22. If you’d like to join a march or start one in your city, sign up on Facebook or contact organize@lowninstitute.org.

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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.

 

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