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Toxic homeopathic products, off-label prescription decisions, and more

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February 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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A STAT report calls attention to the Food and Drug Administration’s current inability to effectively regulate homeopathic products. Since 2006, the FDA has received hundreds of reports of babies experiencing seizures and other complications after using Hyland’s teething products, which contain a diluted neurotoxin. Although the FDA has issued a public warning, the products remain on the shelves because the agency does not have the power to force a recall.

Decisions about prescribing off-label antidepressants by primary care clinicians are often made without evidentiary support, according to a study in The BMJ this week. Out of a sample of more than 100,000 prescriptions, written over a 12-year period, researchers found that only 16% of medications prescribed off-label had strong scientific evidence supporting use of the drug for the indicated condition. For another 40% of prescriptions, a different drug in the same class had supporting evidence, but not the one prescribed. For the rest, neither the prescribed drug nor any in its class had strong evidence to support its prescription off-label.

Health systems and clinicians are finally moving toward providing the right care, according to Hospitals & Health Network. They’re reexamining their protocols and processes, and weeding out waste and unnecessary care. At Kaiser Permanente, for example, chest x-rays are no longer routine for joint replacement surgery. “We drilled down to the evidence base and found that while we were doing what we thought the evidence supported, it really wasn’t always there,” said Stephen Paroldi, MD, of the Permanente Group. The Right Care Alliance and the Lown Institute are cited as leaders in the right care movement.

Scientists and clinicians should not be silent about policies that jeopardize medicine and research, states Duncan Maru, MD, in STAT. He writes that clinicians may fear speaking up because they could be labeled as “activists” or that they might lose research funding. “We must refuse to allow fear to compromise critical thought, open dialogue, and relentless curiosity…,” he writes. He urges individuals to join the March for Science, a non-partisan gathering of scientists and others advocating for evidence-based policies on April 22. Right Care Boston will participate in the local event; other locations are also planned. Interested? Email us at organize@LownInstitute.org.

A new study in NEJM finds that the prescribing patterns of emergency room physicians may contribute to long-term opioid use. Even within the same hospital, some ER doctors were more than three times as likely to prescribe opioids than others, the researchers found. And patients who saw doctors who were “high-intensity” prescribers were 30 percent more likely to use opioids in the future. “Doctors don’t even know what they’re doing is a habit. We have to decide to interrupt ourselves,” says study author Michael L. Barnett, MD, quoted in The New York Times.

Announcements

Last call for Early Bird Registration: February 28 (next Tuesday) is the deadline to register early for the 5th Annual Lown Institute Conference, Beyond the Bottom Line: Defending the Human Connection in Health Care. Register now to take advantage of our discounts for the best medical conference of the year, May 5-7 in Boston.

February 28 is also the deadline for our Right Care Vignette Competition. Submit your vignette describing a case of overuse for the chance to get published in the JAMA Teachable Moments series and to present the case at the Lown Institute Annual Conference.

A live webcast, The 21st Century Cures Act: Indications for Research and Drug Development, presented by the Harvard T.H. Chan School of Public Health and STAT, will be held Monday, February 27, 12:30-1:30 pm ET. The forum explores the implications of the law for biomedicine, regulation, pharmaceuticals and patient advocacy. More information here.

Headlines

Overuse

Access

Clinician health

Cost of care

Doctor-patient communication

Empathy

End of life

Global health

Model of care

Population health

Public health

Quality and safety

Transparency

Women’s health

 

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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