Fast-takes on health care developments worth watching

Here are some fast takes on some developments in health worth watching:

Good news: Birth rates among teen moms have declined to historic lows, falling most sharply (by almost half) for blacks and Hispanics, the federal Centers for Disease Control and Prevention has reported. Many factors may have contributed to this important trend, including greater access by the young to contraception and shifting mores and behaviors that lead to teens having less sex. Even with this positive news about declining teen birth rates, those for blacks and Hispanic still are double those for whites. Taking care of young parents and their kids costs the country an estimated $9 billion annually. Teen moms and their kids suffer short- and long-term health and social well-being consequences, experts say.

Questions on a common, painful back procedure: When U.S. patients appear to suffer “degenerative disc disease,” a condition around which a $40 billion industry has sprouted, their doctors more than 70,000 times annually subject them to a painful, costly procedure called provocative discography. Materials are injected under pressure into several discs─both those suspect and some as experimental controls─as a diagnostic technique. But new research shows this invasive procedure has no proven benefit and may lead to faster degeneration of the injected discs, says HealthNewsReview.org, a health information watchdog site. The site asks why this study, praised by experts it quotes, was ignored by media. The study potentially opens the door to further, needed inquiry about questionable, costly, painful, and potentially ineffective care given for the millions who suffer from back pain, site experts write.

A health bane or benefit: The Royal College of Physicians, one of Britain’s top health organizations, has taken a position contrary to their American counterparts on the risks of electronic cigarettes used in “vaping,” the New York Times reports. Although the Americans, notably the federal Centers for Disease Control and Prevention, have condemned vaping as a health risk, the Brits say they have conducted an extensive review of the evidence and disagree. They say they would rather that their many current smokers give up cigarettes now for the e-cigs, which they find safer. The college says vaping is a major new way to reduce tobacco’s harm by getting smokers to use a less harmful product. The CDC has argued that vaping still exposes users to damage from highly addictive nicotine, as well as undetermined substances used in vaping liquids; the agency also warns that vaping can be harmful to kids, including acting as a gateway to getting them hooked on regular cigarettes. The Times quotes a leading American expert’s retort to the royal college: “These guys, in my view, are going off a cliff. They are taking England into a series of policies that five years from now they all will really regret. They are turning England into this giant experiment on behalf of the tobacco industry.”

Ahead of the curve: As the tech world seeks to advance the number and use of health care apps, federal regulators are letting them know early on that such products may fall under government oversight aimed at protecting patient-consumers. The Washington Post reports that the Food and Drug Administration, the Federal Trade Commission and others are showing up in Silicon Valley big time.   They already have rebuked companies like Theranos, 23andMe, Lumosity and Pathway Genomics with warning letters and fines and “raised questions about products that regulators believe promise more than they can deliver.” The Post notes that intensified regulatory scrutiny is likely in the tech health care field, where life sciences investments by venture capitals have hit a record high in 2015, with $10.1 billion invested in 783 deals. The paper says “total start-up funding is approaching levels of the last dot-com bubble — a development that has some industry observers worried that pseudoscience is being confused with innovation.”

Surgical over-reach, standards: New questions have been raised about surgeons and their “largely unfettered” ability to claim they can perform high-risk procedures for which they actually may have minimal training, the Washington Post says. The paper cites research published in peer reviewed, reputable medical journals showing that patients who underwent such surgeries in hospitals where they were frequently performed had lower death rates; patients had more complications when they were operated on by surgeons who did high-risk operations less often. Volume may be a key way to measure surgeons’ capacity to handle well complex procedures, experts say. The Post says three prominent health systems—Johns Hopkins, Dartmouth-Hitchcock and the University of Michigan—want to require their surgeons and 20 affiliated hospitals to meet minimum annual thresholds for 10 high-risk procedures before undertaking complex procedures. The three systems have asked other hospital networks around the country to join them.

Seven deadly procedures: Health experts are waving red flags about seven operations performed on an emergency basis that account for a startling “80 percent of all admissions, deaths, complications and inpatient costs related to emergency surgeries,” the Washington Post reports. That information was found in a new study that analyzed 421,476 patient records from a national database of hospital inpatients and identified the risky and costly seven as procedures mostly related to digestive system organs─removing part of the colon, small-bowel resection, removing the gallbladder, operations related to peptic ulcer disease, removing abdominal adhesions, appendectomy and other operations to open the abdomen. The paper said the study has limits but the authors say it shows that “there’s value in having quality benchmarks and cost-reduction strategies focus[ed] on these procedures.”

MDs or hospitals deciding care: Some patients, physicians, and Catholic hospitals in Southern California have gotten into a wrangle over religious freedoms and who decides what kind of care patients will receive, a National Public Radio affiliate in Los Angeles reports. The state medical association says it will join with the ACLU in contesting the decision by Dignity Health to bar a doctor at one of the Catholic system’s facilities from performing a tubal ligation on a female patient after her planned Cesarean section. Diginity issued a hospital directive against the doctor and procedure on religious grounds. But the ACLU and the medical association say the hospital system is interfering with medical decisions it shouldn’t meddle in.

More hip implant woes: One of the world’s most commonly implanted metal hips may be more prone to failure than previously believed, with post-2006 models suffering manufacturing issues that may result in the need for further surgical repair, researchers have found. BMJ Blogs has reported online on the study, noting that, despite the decline in use of metal hips hundreds of thousands of the devices are still in patients. The study’s authors say that “a better understanding of the factors associated with a higher risk of failure would not only help those patients fitted with them, but could also inform the design of future products,” BMJ reports.