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Morning Briefing

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Monday, Jan 4 2016

Full Issue

Views On Health: Using Patients' Cells For Research; Fighting Opioid Addiction

Commentators examine some consumer and patient issues.

This often surprises people: Tissues from millions of Americans are used in research without their knowledge. These 鈥渃linical biospecimens鈥 are leftovers from blood tests, biopsies and surgeries. If your identity is removed, scientists don鈥檛 have to ask your permission to use them. How people feel about this varies depending on everything from their relationship to their DNA to how they define life and death. Many bioethicists aren鈥檛 bothered by the research being done with those samples 鈥 without it we wouldn鈥檛 have some of our most important medical advances. What concerns them is that people don鈥檛 know they鈥檙e participating, or have a choice. This may be about to change. (Rebecca Skloot, 12/30)

Over the course of my reporting, I鈥檝e talked to hundreds of people who say their medical records were hacked, snooped in, shared or stolen. Some were worried about potential consequences for themselves and their families. For others, the impact has been real and devastating, requiring therapy and medication. It has destroyed their faith in the medical establishment. (Charles Ornstein, 12/30)

There is a grim connection between two worsening addictions in the U.S.: to prescription opioid painkillers and to heroin. Both can be partly traced to worthwhile public-health initiatives that deserve to be protected. The first initiative was a 1990s campaign to get doctors to take people's pain more seriously. This worked amazingly well -- for some people, too well. The second effort was the recent response to the ensuing spike in opioid addiction: Legal controls on painkiller prescriptions were tightened, and some of the drugs were reformulated to make them harder to overuse. (12/31/15)

The conflict between health plans and providers over coverage of medication-assisted treatment for patients with opioid addiction highlights the ongoing tensions over government regulation of insurance benefit packages. And it raises questions about whether current benefit designs of private health plans are necessarily consistent with the broader public health goals. (Harris Meyer, 12/28)

In the contrast between what has happened since 1964 with tobacco, on the one hand, and marijuana, cocaine, heroin and other banned substances, on the other, we have an instructive lesson in the comparative effects of choosing a public-health or a criminalization paradigm for dealing with addictive substances. The approach to tobacco has worked. Between 1964 and 2014, smoking rates declined by half; between 1996 and 2013, the number of eighth-graders who had smoked within the past 30 days fell from 21鈥塸ercent to 4.5 percent. The progress against smoking has been steady and impressive. It鈥檚 an altogether different tale with banned substances. (Danielle Allen, 12/29)

But there is also a self-serving motive for letting intemperance go unchecked. An angry patient is far more likely to grade me poorly than a satisfied one is to grade me highly on one of the many doctor-rating Internet sites. I am also subjected to patient satisfaction surveys as dictated by the Affordable Care Act. Here鈥檚 a reasonable-sounding sample question: 鈥淗ow often did doctors treat you with courtesy and respect? The possible answers are 鈥渘ever,鈥 鈥渟ometimes,鈥 鈥渦sually鈥 and 鈥渁lways.鈥 My hospital has made it clear that some of the federal funding we receive is tied to the proportion of 鈥渁lways鈥 answers; we get no credit for 鈥渦sually,鈥 which might as well be 鈥渘ever.鈥 Nor is there a mechanism to identify what a patient might consider disrespectful. (Sarah Poggi, 1/1)

Here's a breathtaking statistic: Teen smoking has plummeted by half or more in just five years. Half! More teens than ever are wising up to the dangers of tobacco and shunning cigarettes, according to the latest survey from the University of Michigan's Monitoring the Future study. (1/2)

There are many reasons it doesn鈥檛 make sense to have a separate, federally managed health care system for our nation鈥檚 veterans. From the veterans鈥 perspective, the issue is typically one of access, as they are often forced to travel hours to the nearest U.S. Department of Veterans Affairs health care facility .... From the taxpayers鈥 perspective, this separate system is also problematic, creating needless and costly redundancies in service .... But it鈥檚 also a problem from a regulatory perspective. The VA can, and does, employ doctors and other health care professionals who aren鈥檛 even licensed in the states in which they practice. (1/4)

Our aging, ill prisoner population is both a humanitarian crisis and an economic challenge that demands the collaborative attention of physicians, corrections officials, legislators and advocates who can devise national guidelines for medical parole. Dr. Brie Williams, a palliative care physician at the University of California, San Francisco, who is an expert in correctional health, has called for a national commission to develop an evidence-based approach to address the compassionate release process, with an eye toward reducing the red tape that can tie up critical cases when every day matters. It shouldn鈥檛 be acceptable that my patient, who posed no danger to the community and who had a family who loved him, should have died incarcerated. (Rachael Bedard, 12/28)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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