Most of what I’ve read and previously written about electronic health records has been about making them work better or getting more clinicians to use them. Security of patients’ on-line data hasn’t been a major topic of concern. I’ve assumed that this was because these concerns had mostly been addressed back in the late 1990s during the development of the Health Insurance Portability and Accountability Act (HIPAA), or because those creating systems to allow medical information to be internet accessible – like those coalitions building dedicated Health Information Exchanges and companies like Microsoft, Google, and BlueCross BlueShield insurance plans – have resolved the security concerns.…
Cracking Down on Fake Cancer Cures
The FDA announced today that they have sent letters to 25 companies to stop selling fake cancer cures. That is, things that the companies claim cure cancer, but have never been tested, or approved by the FDA. The FDA has a web-site with more information about this, and a sub-page that lists 125 Fake Cancer Cures.
I know the FDA gets lots of flack for not doing enough – and not doing it fast enough – I applaud the FDA for taking this action, and encourage them to do more because I have found the advertisement and selling of these non-medicines troubling for a long time.…
MedPAC Gets Real About Promoting Primary Care
The Medicare Payment Advisory Commission released its annual report to Congress on Friday. In chapter 2 of its report, MedPAC makes two significant proposals for improving the financial incentives for primary care providers.
Great Incentives for Primary Care Practitioners Not Just Primary Care Services
First, it recommends changing Medicare’s reimbursement system for “evaluation and management” (E&M) services. While last year Medicare increased payments for E&M services, they couldn’t differentiate between types of physicians providing these E&M services, i.e. the Medicare system doesn’t distinguish between a family physician and a cardiologist if they are providing the same type and level of intensity of service.…
Biomarkers Improving Regulatory Reviews and Drug Development
The FDA announced yesterday that both the FDA and the European Medicines Association (EMEA) will accept seven biomarker tests for early kidney damage. These animal based tests were developed by a public-private collaborative and will be a voluntary part of the regulatory applications for new drugs. However, it is believed that companies will benefit by doing these test because they will both be able to detect toxicity problems earlier in a drugs development, and enable the approval of more powerful drugs, “because health care professionals could closely monitor patients and halt the drug if early signs of renal toxicity appear.”
…“The development of these and other biomarkers can result in important tools for better understanding the safety profile of new drugs,” said Janet Woodcock, M.D.,
Vitamin D – It’s Not Just About Bones
Today’s Boston Globe has an article about a study from Children’s Hospital in Boston that explores the high rate of insufficient vitamin D in otherwise healthy infants and toddlers. (12% deficient in vitamin D and 40% with suboptimal levels.) The study also noted that one-third of these children with low levels of vitamin D had pathological bone changes seen on x-rays.
What Does Vitamin D Do?
What the research study did not examine – but the Globe story does mention – is that in recent years there has been extensive investigation and speculation about the role of vitamin D plays in many other areas of health besides strong bones and teeth.…
Nature v. Nurture – Smoking and Other Complex Problems
A long-standing debate in the life sciences has been the role of nature versus nurture in determining individual characteristics. For example, how much of an individual’s height is determined by their genes and how much by their nutrition – both in childhood and prenatally?
In the last few decades advances in our understanding of genetics has shifted this dichotomy to describe it in terms of genetics versus environmental factors, and expanded our appreciation for the role nature/genetics play in causing all manner of human diseases. For example, it was discovered that genetically determined slow serotonin transporters in the brain can predispose individuals to developing depression.…
Behavorial Economics and Fixing Healthcare’s Cultural Problems
Peter Orszag, (the Director of the Congressional Budget Office), delivered a very interesting speech last week to the National Academy of Social Insurance about “Health Care and Behavioral Economics.” He discussed how behavioral economics – which combines insights from psychology and economics – can both help to explain cost and quality problems in the US health care system and be used to begin developing solutions to these problems. This seems – at least to me – to be a very reasonable approach to understanding why individuals and populations don’t respond according to standard economic theory – which assumes both perfect knowledge and benefit maximizing actions.…
Tax Exempt Status for Health Care Organizations – Get Some Fact$
I’ve been following the controversy about the tax-exempt status of non-profit organizations* since several hospitals (including the major teaching hospital affiliated with my alma mater) were chastised several years ago for charging uninsured patients more than insurance companies would have paid, and then sending collection agencies after these people. This was follow-up by Congressional hearings and investigations. More recently a bill was introduced here in Massachusetts to tax college and university endowments that are over $1 billion (which includes my undergraduate alma mater), and a few days ago the New York Times had an article about this issue and a state court case denying the tax-exempt status of a daycare center.…
Summertime, Timing, Planning, and Boring Medicine
Memorial Day weekend is the traditional start of summer. This weekend also brought me in touch with some other markers of time, including:
- A great celebration of life event for the passing of a friend’s father – a terrific gentle bear of a man who had faded away in recent years after more than four score years
- A double birthday party for the children of some friends – a 9 year old and a first birthday
- Senator Kennedy’s long tenure and track-record of accomplishments – which were chronicled in many news reports following his being diagnosed with a brain tumor
I was also reminded of the importance of planning over time by a recent op-ed that mentioned a national organization’s call for increasing medical school enrollment in order to avoid a future shortage of physicians.…
More Perspectives on Health Information Technology – Can We Call It Prevention?
A few weeks ago I wrote about the challenges of adopting electronic medical records to provide value for different stakeholders and the entire health care system. Well, this week the Congressional Budget Office released a paper on “Evidence on the Costs and Benefits of Health Information Technology.” This paper is a reasonable review and synthesis of the literature, but it’s important to recognize that the CBO’s mission is to focus on how federal legislation can change government spending.
While the paper concludes that savings from adopting HIT are generally uncertain, it does make some supportive comments about its value.…
Baseline and Goals of Treatment
While watching the Red Sox-Milwaukee baseball game on TV last Saturday, the announcers were discussing Julio Lugo, the Red Sox shortstop who had missed 5 games with a concussion. One of them noted that the team had done baseline neuroimaging testing on all the players so if they had a concussion during the season they would have a baseline to compare to their post-concussion tests. I assume that they also did non-imaging neurological testing, such as reflexes and memory, etc., and this was an extension of all the other evaluations the players went through.
The reason I found this interesting is that it highlights the importance of having an understanding of both a patient’s baseline and their goals.…
End of Life Issues: Clinical and Cost Considerations
At a policy related forum for medical residents at the Massachusetts General Hospital last week, one of the questions was about end of life care. The other panelists and I answered from a clinical perspective – and I also put a plug in for the Kenneth B. Schwartz Center which does educational programs for clinicians about strengthening patient-caregiver relationships and communications.
However, during the informal discussion after the panel, a number of the residents raised questions about how much of our healthcare spending goes for treating people at the end of life. In talking with them about this, I recalled three things having looked at this issue several years ago: First, there is a lot of public misunderstanding and misrepresentation of information about this topic.…