Articles Posted in Research Studies

fda3smokewarns-300x166The U.S. government will try to tackle two of the toughest health care challenges around with new pushes involving graphic imagery and smoking prevention and the encouragement for doctors to screen their adult patients to better detect, avert, and treat drug abuse.

Both initiatives have their soft spots.

But officials say they must act in as many ways as they can. That’s because 480,000 people in the United States die each year from illnesses related to tobacco use, the American Cancer Society reports, adding, “This means each year smoking causes about 1 out of 5 deaths in the US.” Drug abuse and overdoses, meantime, killed more than 68,000 Americans in 2018 alone, exceeding the nation’s peak annual deaths from car crashes, AIDS or guns, the New York Times reported, based on data from the federal Centers for Disease Control and Prevention (CDC).

beaumonthospital-300x115When doctors become medical outliers, shouldn’t hospitals, colleagues, insurers, and the rest of us ask how and why an individual practitioner diverges so much from the way others provide care?

Olga Khazan details for the Atlantic magazine the disturbing charges involving Yasser Awaad, a pediatric neurologist at a hospital in Dearborn, Mich. As she describes him, for a decade he racked up hundreds of cases in which he is accused by patients of “intentionally misreading their EEGs and misdiagnosing them with epilepsy in childhood, all to increase his pay.” Khazan says his case “shines a light on the grim world of health-care fraud—specifically, the growing number of doctors who are accused of performing unnecessary procedures, sometimes for their own personal gain.”

In the malpractice cases that are unfolding against him, Awaad’s pay has become a central issue, with evidence showing his hospital contract rewarded him for boosting the number of screenings he ordered and diagnoses he made. Jurors have been told that Awaad, whose salary increased from 1997 to 2007 from $185,000 annually to $300,000, “turned that EEG machine into an ATM.” He earned bonuses exceeding $200,000, if he hit billing targets.

pretomanid-300x122Rare good news on destructive infections is emerging from Africa: Medical scientists, Good Samaritans, and public health officials are hailing the successes of powerful new therapies in treating a deadly and extremely drug-resistant strain of tuberculosis and Ebola, a killer viral hemorrhagic fever that spreads like wildfire.

Americans may skip over dispatches about these “foreign” news developments. They would be wise not to do so, because they have heightened importance these days, domestically, including in providing key lessons to be learned about how to safeguard the public health.

The TB care that is winning great attention overseas requires patients to take three drugs in a regimen in which they take five pills a day for six months. That already is a boon compared with other, now common therapies in which they might need 40 pills a day for as long as two years, or daily antibiotics shots with bad side effects like deafness, kidney failure, and psychosis.

footballrochester-300x200Although commentators and pro football itself have argued that rule changes by the National Football League have notably reduced possible head harms, new evidence from college athletes shows that even knocks that aren’t severe enough to be deemed concussions may injure young brains.

Those findings come from a University of Rochester study based on brain scans and helmet data from members of the school’s Division III football team (shown above), the New York Times reported.

Researchers scanned the athletes’ mid-brain area twice, once before the season kicked off and at its end. They did so because that region would most likely show the effects of impacts, including those that might be tougher to gauge in other areas of the brain. They also compiled data from special equipment on players’ helmets, registering the number and intensity of every impact — not just from player collisions but also when athletes hit the ground.

zolegensma-300x225Big Pharma is testing crucial boundaries in the way that the nation determines the safety and effectiveness of prescription medications. And regulators, for patients’ sake, need to shove back — hard.

The concerning incidents involve “pay to play” clinical trials and “manipulated” data submitted to the federal Food and Drug Administration by maker Novartis as part of the approval process for a gene therapy drug with a sky-high price.

Neither instance, officials insist, had immediate effects in endangering patients. But both show extreme practices and conduct that regulators should slam to a halt.

axiosinsurancecost-300x170With the 2020 presidential campaign obsessing early about health insurance rather than costly health care overall, voters may wish to reframe their thinking about coverage and candidates’ views on making it affordable. Their chief query may need to be this: Just how much of the vig should the bagman take?

That may be a blunt a way to put it, but is the vernacular of the criminal “protection” racket all that out of place here? Michael Hiltzik, a financial columnist for the Los Angeles Times, makes pretty much the same argument, that the bagman’s share ought to be zero.  Why not get rid of health insurers, he asks in a bit of evidence-based hyperbole? He finds the companies don’t fulfill much of a public mission, save, as a former insurance executive describes it, to make themselves money and to persuade all of us that they are essential. Indeed, as Hiltzik sees it, insurers are not just a rip-off but a failure in their own terms:

“Let’s start by examining what the insurers say are their positive contributions to healthcare. They claim to promote ‘consumer choice,’ simplify ‘the health care experience for individuals and families,’ address ‘the burden of chronic disease,’ and harness ‘data and technology to drive quality, efficiency, and consumer satisfaction.’ (These claims all come from the website of the industry’s lobbying organization, America’s Health Insurance Plans (AHIP). They’ve achieved none of these goals. The increasingly prevalent mode of health coverage in the group and individual markets is the narrow network, which shrinks the roster of doctors and hospitals available to enrollees without heavy surcharges. The hoops that customers and providers often must jump through to get claims paid impose costly complexity on the system, not simplicity. Programs to manage chronic diseases remain rare, and the real threat to patients with those conditions was lack of access to insurance (until the Affordable Care Act made such exclusion illegal). Private insurers don’t do nearly as well as Medicare in holding down costs, in part because the more they pay hospitals and doctors, the more they can charge in premiums and the more money flows to their bottom lines. They haven’t shown notable skill in managing chronic diseases or bringing pro-consumer innovations to the table.”

With back-to-back-to-back incidents of mass gun violence killing almost three dozen children, women, and men, can this nation muster the political courage to treat this lethal scourge as a public health menace?

Can it, finally, green light and fund rigorous research that could inform public policies that both could protect Americans’ Second Amendment rights while also reducing the estimated 40,000 or so firearm deaths that occurred in 2018 alone?

For what it is worth, there is considerable and (what should be) convincing evidence that:

nprsuicide-300x224The nation’s rising suicide crisis torments seniors, too, with just under one out of five such deaths in 2017 occurring with individuals 65 and older. Men 65-plus, experts say, face the highest suicide risk, while seniors 85 and older, men and women, rank No. 2 in groups most likely to die by taking their own lives.

As the nation grays — 10,000 baby boomers a day turn 65, in a trend that will persist until 2029 — the already high concern about suicide, especially among seniors, is rising,  National Public Radio reported.

NPR, noting that suicide already is the 10th leading cause of death among all Americans, said that experts see loneliness, bereavement, grief, and depression as key factors in cases in which older individuals kill themselves. They find themselves isolated, overwhelmed, and with unending sadness when spouses and friends die. Their children, grandchildren, and other family members often live far away. They also struggle with their lives due to age’s increasing debilitation. As NPR reported:

bimplants-300x150An Irish medical manufacturer voluntarily withdrew its textured breast implant and related tissue expanding devices from markets after the federal Food and Drug Administration tracked a spike in a rare cancer and deaths tied to the products and asked that they be recalled.

U.S. regulators, the New York Times reported, lagged their European counterparts by almost a year in acting to protect women seeking cosmetic and reconstructive procedures involving the Allergan implant:

“Worldwide, 573 cases and 33 deaths from the cancer have been reported, with 481 of the cases clearly attributed to Allergan Biocell implants, the F.D.A. said. Of the 33 deaths, the agency said its data showed that the type of implant was known in 13 cases, and in 12 of those cases the maker was Allergan.”

surgicaltools-300x200
Would a major league baseball team start a pitcher who played only once in the season for the deciding game of the World Series? Would passengers want to be aboard a jet whose pilot flew just once a year? Would any high-end sports car owner let a mechanic under the vehicle’s hood if she fixed that model one time every 365 days?

If rigorous tasks benefit from regular, quality practice — and they do — then why do hospitals allow low-volume surgeons to undertake procedures they rarely perform? That’s a tough question posed by new research from the Leapfrog Group, a national nonprofit organization seeking to improve the quality and safety of American health care.

Leapfrog, working with medical experts, identified eight high-risk surgeries and sought to estimate from rigorous published research the correlation between how often surgeons perform these and their procedures optimal outcomes.

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