In a recent New York Times article, physician-author Siddhartha Mukherjee wrote about a clinical trial that he characterized as “beautiful,” for potentially illuminating a surprising connection between heart disease and cancer. Mukherjee is a justifiably acclaimed writer, who publishes regularly in The New Yorkerand The New York Times, and who won a Pulitzer for his bestselling book The Emperor of All Maladies. But I wonder whether the demands of popular writing have caused him to hype a treatment that, while promising, is far from proven.
The treatment targets inflammation by inhibiting an interleukin molecule. Researchers conducted a huge clinical trial to see whether the treatment would reduce the kind of inflammation that damages arteries. But Mukherjee didn’t write about the drug because of its ability to prevent heart attacks or strokes. Instead, he was excited about the trial because a secondary analysis of the data showed a “drop in all cancer mortality” and a “stark decrease” in deaths from lung cancer.
Mukherjee knows that secondary analyses like this need to be viewed with caution. Measure enough outcomes in a clinical trial, and the statistics of chance predict that the intervention will falsely appear to reduce some kind of medical problem or other. He even acknowledges that this cancer finding needs to be replicated. However, he isn’t content to urge readers to remain in a state of scientific caution, proclaiming that “if the benefit holds up in future trials, interleukin-1-beta inhibition could eventually rank among the most effective prevention strategies in the recent history of cancer.”
Holy moly, that’s a misleading sentence! (To read the rest of this article, please visit Forbes.)
For my entire life, a half century and counting, healthcare spending in the U.S. has almost always risen faster than inflation. Sometimes it’s relatively slow, sometimes it’s relatively fast, but no matter the time, healthcare spending is climbing. Getting healthcare spending under control is really important for us to do if we hope to have any money left in this country to spend on other important things. You know–like food, shelter, education. That kind of stuff.
So are we in the process of getting healthcare spending under control? A couple recent studies shed light on this question.
The first comes from the Bureau of Economic Analysis, an agency within the Department of Commerce. Using a new measure, researchers at the Bureau were able to break down healthcare spending by disease, or at least by a general category of health conditions: cardiology care, for instance, versus cancer care. They looked at two time periods: 2000-2005, a time period of high growth in spending, and 2006-2010, a time of slower growth. They tried to figure out what explained the slower growth in that time period.
Their biggest finding was that the slowing of growth did not occur primarily because fewer people got sick. Growth didn’t slow down, for example, primarily because cholesterol treatment reduced the number of people experiencing heart attacks. Instead, spending slowed mainly because the cost of treating people with problems like heart attacks stopped rising so quickly, what the researchers called the “cost per case” of treatment. Here’s a picture showing that result, with the cost per case line essentially flattening out between 2006 and 2010:
This slowdown in cost per-case spending wasn’t uniform across health conditions. Between 2006 and 2010, care for circulatory conditions grew less than half as quickly as it did between 2000 and 2005. By contrast, the rise in the cost of cancer care didn’t slow one iota over that latter time.
To read the rest of this article, please visit Forbes.
Cholesterol pills are one of the great medical advances I’ve witnessed during my professional career. I am talking specifically about a category of medications called statins, drugs like Lipitor and Pravachol. These drugs have prevented probably hundreds of thousands of heart attacks and strokes. Only one problem with these drugs, however: statins won’t help people who don’t take them. And according to a study in the prestigious Annals of Internal Medicine, when physicians prescribe trade versions of statins rather than generics, the extra cost dissuades many people from filling the prescription. If physicians want to help their patients, they need to prescribe affordable versions of accepted medical interventions.
The study was led by Joshua Gagne, a pharmaco-epidemiologist (a person who lives and breathes hardcore data on medications and population health) at Harvard (an up and coming university located, I think, somewhere near Boston). Gagne and colleagues analyze data from Medicare patients who got their prescription benefits from CVS Care Mark. (To read the rest of this post and leave comments, please visit Forbes.)
The National Health Service in the United Kingdom has recently disseminated a wonderful graphic, helping people understand how likely they are to die from scary things, like war and airplane accidents, versus less terrifying but deadlier hazards, such as high blood pressure and high cholesterol: In behavioral economics, we talk about something called the “availability heuristic,” a fancy term meaning – when we try to guess how likely things are to happen, we use as a simple rule of thumb how easily instances of those occurrences come to mind. Things that come easily to mind, we assume, are more common. It’s easy to think of airplane accidents, because they’re covered in the news. Nothing newsworthy about a 90-year-old man dying from smoking related illness. This graphic is powerful, because it acts as a visual reminder of what we really ought to be scared about.
It is well known that Medicare expenditures threaten the financial solvency of the U.S. government. And it is pretty well agreed upon that some of our Medicare spending goes towards wasteful medical care. But which medical care is wasteful and how much is such care costing us? A study in JAMA Internal Medicine provides a sneak peek at answers to these important questions. The research, led by Aaron Schwartz , a graduate student at Harvard, focused on interventions that medical experts deem to provide little or no health benefit. For example, the Choosing Wisely campaign, promoted by medical societies, has concluded that testing people’s lung function prior to low and intermediate-risk surgeries does not improve surgical outcomes. Similarly, the United States Preventive Services Task Force has concluded that colon cancer screenings yield more harms than benefits for elderly patients.
The researchers explored how often Medicare beneficiaries received unnecessary services like this, a list of 26 tests or procedures that medical experts have deemed to be unnecessary. The researchers discovered that Medicare patients, on average, received one such intervention per year. The worse culprit, financially speaking, was stenting (propping open) coronary arteries for people with stable heart disease, which by one of their estimates leads to almost $3 billion per year of wasted Medicare spending. Close behind was another cardiology procedure, stress testing for patients with stable heart disease, which triggered over $2 billion of unnecessary spending. Toss in $200 million per year for unnecessary back imaging, another $200 million for unnecessary imaging tests to evaluate headaches, and the researchers uncovered over $8 billion of Medicare waste, for just these 26 interventions. (To read the rest of the article and leave comments, please visit Forbes.)
High costs make it hard for many patients to afford their medications. That’s why some medical experts believe we should give important medications to patients for free, to see if that improves their health outcomes. One famous example of this approach is the MI FREEE Trial, which offered free cardiovascular medication to patients who would experience heart attacks. The trial increased the percent of patients taking their heart medicines, medicines known to reduce the likelihood of subsequent heart attacks. In the case of minority patients, these free medicines significantly improved their long term health. (Visit Forbes to read more and view comments.)
Ten years ago, my tennis partner suffered a stroke. He was a sixty-year-old at the time, working to move up into the top ten players in his age group. In the country! You could not have found a healthier sixty-year-old. He played tennis three-plus hours a day, scampering across the court like a hyperactive adolescent. In other words, he was not the kind of cigarette smoking, hypertensive elderly man you would expect to experience a stroke from clogged and battered arteries.
I wasn’t shocked to learn, then, that he had a PFO—a patent foramen ovale. The foramen ovale is a passageway connecting the right and left atrium in the heart, a crucial opening for all of us when we were fetuses because it allowed our bodies to shunt blood from the right and left side of the heart without having to pass through what, in those circumstances, were non-functional lungs. For most of us however, the first time we took a breath of air after being born, our foramen ovales began to close, the two sides of the wall separating the atria eventually fusing. But in the case of my tennis partner, that FO remained a PFO. He lived for sixty years unaware that there was a hole still open between the two sides of his heart. Eventually that PFO contributed to his stroke, providing an opening for a blood clot to sneak across to the left side of his heart where it then was pushed, with the contraction of his left ventricle, up towards his brain.
My tennis partner survived the stroke and was soon playing tennis again. Determined not to experience another stroke, he chose to have his doctors close his PFO.
But should he have made that choice? And should his insurance company have paid for the procedure? …(Read more and view comments at Forbes)