�鶹Ů��

Precision medicine is the next big thing in health care, and it’s also one of the few health goals that Congress and the White House agree on. But while we await treatments targeting the precise genetic makeups of individuals and diseases, medical researchers still are not paying enough attention to the most important kinds of differences among patients: those of sex, age and race. A clear example of this disconnect is the 21st Century Cures Act. (Susan F. Wood, and Diana Zuckerman, 11/19)

[LabMD's] work required securely storing personal-health data and medical records in compliance with Health and Human Services Department regulations under the Health Insurance Portability and Accountability Act, often known as HIPAA. ... in May 2008, LabMD was contacted by Tiversa, a company that describes itself as a “world leader in P2P cyberintelligence,” alleging that it had found on the Internet a LabMD insurance-agent file containing the names, dates of birth and Social Security numbers of about 9,000 patients. ... the company demanded a fee of $40,000 to mitigate the situation. After leading its own thorough review that turned up no sign that any patient information had been exposed online, LabMD refused to pay. Little did it know that this would lead to a yearslong fight with the federal government that would bring down the company. (Dan Epstein, 11/19)

Here’s good news for policy makers—on the right and left—concerned about poverty in the United States. A new study by economists Bruce Meyer of the University of Chicago and Nikolas Mittag of Charles University shows that public-assistance programs are far more effective in alleviating poverty than many government statistics suggest. The problem lies in the way the U.S. Census Bureau measures poverty. According to the bureau’s website, the government’s “official poverty definition uses money income before taxes and does not include capital gains or noncash benefits (such as public housing, Medicaid, and food stamps).” This has long been known to underestimate income sources and material well-being in low-income households. (Robert Doar, 11/18)

Virginia Republicans made a mistake when they tried to spin a recent report on Medicaid inefficiency as a reason to continue opposing Medicaid expansion. But they stand on firmer ground when they point with alarm to a recent spike in Medicaid costs. Surging enrollment — 50,000 new enrollees in the past five months — will drive up the program’s cost to the commonwealth by just under $1 billion. That likely will squeeze out new spending on everything from education to state parks. (11/19)

There's a new cancer treatment strategy in the news: Wait and see. Time magazine ran a cover story on simply watching small breast cancers; the Wall Street Journal similarly reported on watching small thyroid cancers. So-called watchful waiting has been a long-standing option for early prostate cancers. (H. Gilbert Welch, 11/19)

Talk to any executive at any large organization about gender equality and at some point they'll give the same reason/make the same excuse (take your pick) for the disparities between how men and women are treated in the workplace: Pregnancy. So maybe it's time to impose mandatory male parental leave to de-stigmatize pregnancy breaks to help crack the glass ceiling. (Mark Gilbert, 11/20)

Doctors swear to do no harm, but I knew I was about to inflict great suffering on my patient Gary, who had been diagnosed with extensively drug-resistant tuberculosis, or XDR TB. Many people wrongly assume that tuberculosis has been eradicated. In fact, according to the World Health Organization, tuberculosis killed more people in 2015 than HIV/AIDS. The strain affecting Gary is difficult to cure. Eighty percent or more of patients with XDR-TB die of their disease. There is grueling, toxic treatment available, but it doesn't guarantee a cure. Gary would be facing permanent nerve damage. Constant nausea. Kidney damage. Hearing loss. He would have to take 10 to 12 drugs at a time for almost a year, and his follow-up treatment would last for another two years. (Caitlin Reed, 11/18)

Freddie Gray, a 25-year-old black man, died on April 19, 2015, from injuries he sustained while in the custody of the Baltimore Police Department. The details of his arrest spurred protests over the unjust treatment of black Americans by the police. As directors of an urban internal medicine residency program in Baltimore, we sought strategies to help our residents, faculty, and staff process these events and their social context. Inspired by our residents' desire to improve our hospital's neighborhood, we intend to translate their sense of urgency into meaningful action, in part by revising our curriculum to emphasize physicians' responsibility for improving community health. (Sammy Zakaria, Erica N. Johnson, Jennifer L. Hayashi and Colleen Christmas, 11/19)

President Barack Obama and congressional appropriators are looking for savings to offset new federal spending programs. One proposal on the table – drawn from the president's budget plan – would disproportionately impact low-income seniors who rely on prescription medications for serious medical conditions. The measure, estimated to save $8.9 billion over ten years, would increase copayments for brand name drugs for Medicare Part D beneficiaries who receive extra financial assistance under the Low Income Subsidy (LIS) program. (Grace-Marie Turner, 11/20)

The complex tasks of developing, evaluating, and determining the appropriate use of medical technologies occur in an evolving ecosystem of diverse stakeholders. However, as new medical therapies and diagnostics are designed and tested, the preferences and views of the patients and care partners who are most directly affected by these treatments are all too often overlooked. Individual patients often experience different effects of diseases and may have unique preferences about treatments or diagnostic procedures that differ from those of other patients or of their physicians or other health care practitioners; they may also have differing views about what kinds and degrees of risk are tolerable. ... Programs recently enacted at the US Food and Drug Administration (FDA) are focused on including patient perspectives throughout the continuum of medical product development. (Nina L. Hunter, Kathryn M. O’Callaghan and Robert M. Califf, 11/19)

Escalating drug prices have alarmed physicians and the American public and led to calls for government price controls. Less visibly, they have also spawned a flurry of private-sector initiatives designed to help physicians, payers, and patients understand the value of new therapies and thus make better choices about their use. Programs recently introduced or advanced by nonprofit organizations, including leading medical professional societies, represent an important innovation in the United States, but they have also revealed numerous analytic and implementation challenges. (Peter J. Neumann and Joshua T. Cohen, 11/18)

In June 2015, the American Society of Clinical Oncology (ASCO) published a proposed framework for assessing the value of various cancer treatments. The goal was to evaluate selected treatment regimens on the basis of their clinical benefit, toxicity, and cost. ... the cost of cancer care has been growing rapidly: though it accounts for a relatively small portion of overall U.S. health care expenditures, it is expected to increase from $125 billion in 2010 to $158 billion in 2020. The costs of cancer drugs amount to only 5 to 20% of the total costs of cancer care, depending on how many of the multiple cost components are included. But the average cost of some newer cancer drugs is now $10,000 to $30,000 per month. ... The costs of copayments, out-of-pocket expenses, and rising insurance premiums exceed many patients' capacity to pay. (Robert C. Young, 11/18)